Today is the 36th day of the 105-day legislative session. The Legislature has 69 days to complete the business of adopting the state operating budget for 2023-25 and passing policy measures that prioritize state government’s work. Both the House and Senate will release budget proposals following the upcoming Marcha20, 2023, state revenue forecast. That means that budget leaders are working now to determine spending priorities for the upcoming two-year budget.
A bipartisan group of Senate leaders is meeting frequently for a line-by-line review of the operating budget. We applaud this bipartisan approach to the state operating budget. Regardless of political affiliation, every Washington family will be touched by the need for long term care. Once the House and Senate have released budget proposals, both chambers will need to agree on a final proposal that will drive state spending from July 1, 2023, through June 30, 2025.
In addition to our work in public testimony, we continue our round of meetings with legislative and budget leaders, and are working on setting the course for next steps. While we want to update you about our work, we also rely on you to help drive critically important information to your legislators.
Please act now to advocate for our budget and policy priorities.
Your advocacy work with legislators is important now. Please send your email to Washington legislators urging Medicaid funding support. Also, feel free to contact Eric Negomir to learn about ways you can help engage your teams in advocating for long term care.
Budget priorities in brief.
There is a direct relationship between the bottlenecks at local hospitals and the lack of basic, adequate funding for long term care. Our providers cannot compete for workers, and thus cannot admit patients who are ready for hospital discharge. People with medically urgent needs cannot access a hospital bed when they need it because the bed is filled by someone who can’t find post-acute care in the community. This vicious cycle must be addressed in the budget, and with supporting policy that provides continuity and stability. One in three Washingtonians will require long term care services and supports in coming years, and the system to provide these services must be available. The human cost is tremendous when people do not have access to care.
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Here are our budget priorities for the skilled nursing, assisted living, and enhanced services facilities.
Assisted living provides personal care, housing, and limited nursing services for low-income seniors.
Assisted living Medicaid funding is currently dialed back to 68% of the actual cost of care, and low-income seniors who could be well served in this setting are being turned away every day. Our priority is to ensure that 100% of the labor costs are funded for Medicaid clients. Current rates reimburse wages below the state minimum wage. This is not sustainable, and we urge budget support for funding for base assisted living Medicaid rates, specialized dementia care, and enhanced community services contracts. Adequate Medicaid funding is the key to opening access for low-income citizens to this setting. See the brief on assisted living Medicaid funding.
Sustainable skilled nursing facility Medicaid funding policy is critical for care access at hospitals and in nursing homes.
Our priority policy legislation (SB 5526 HB 1571) to ensure that Medicaid rates are updated more regularly and that funding is targeted to worker wages was subject to public hearing in the Senate Health and Long Term Care on Thursday. Watch the bill hearing. I testified on behalf of WHCA and LeadingAge, and was joined by Tonja Myer, administrator at Christian Health Care Center in Lynden. Testimony was rounded out by SEIU representatives who are also strong proponents and partners in supporting this important legislation.
Enhanced services facilities can support “difficult to discharge” hospital patients.
Individuals who languish in hospitals for the longest span of avoidable days are there because of the lack of available placements that provide intensive behavioral health supports along with nursing care.
Enhanced services facilities are serving some of the state’s most complex long term care behavioral clients at a cost savings to the state, but payment shortfalls and case management challenges are limiting access. Enhanced services facilities provide a less restrictive setting for people who have severe behavioral diagnoses and need nursing and personal care services, but do not need psychiatric hospital care. We are seeking policy and budget support for difficult-to-discharge hospital residents.
Breaking workforce barriers.
At WHCA, we have been working at the policy level for many years to help inform a strategic direction for the long term care workforce. We know it is difficult to recruit and retain workers for these challenging and important jobs when labor costs are not reimbursed by Medicaid. When you layer in the system barriers, and the expense involved in obtaining necessary training and certification, it is no wonder that prospective workers pass on long term care. While our work with the Nursing Commission has helped frame problems and offered limited solutions, we must ask the Legislature to do more around the long term care workforce.
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On February 1, I testified to support SB 5582, Senator Holy’s legislation to increase the supply of nurses in Washington. The bill has some particularly important ideas related to increasing the number of nurses here in Washington. This bill report provides a quick synopsis of the legislation.
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On February 10, I testified in a public hearing on HB 1694, a bill about home care aide training. I focused on the importance of the home care aid workforce to our assisted living providers and using data to inform decisions and policy direction related to the workforce.
Health Care Authority is expected to do more about Medicaid managed care program integrity.
Senators Lynda Wilson (R-17) and Christine Rolfes (D-23) are advancing legislation related to Medicaid Managed Care Program Integrity (SB 5497). At issue is the Health Care Authority administration and oversight of the managed care organizations. I testified to support the legislation, and explained to Ways and Means Committee members that because managed care organizations are setting arbitrary rates for skilled nursing facility care, people are backed up in hospitals at great cost to the system.
Valentines to be delivered to legislators on February 14
Tomorrow, the teams from WHCA and LeadingAge are convening on the 4th floor of the Legislative Building to provide valentine’s cookies and handmade valentines to legislators and staff. This awareness campaign is a nostalgic way to remind legislators about the importance of long term care services and supports provided by skilled nursing, assisted living, and enhanced services facilities. Thanks to everyone who helped contribute to this effort, we will reach out to invite your legislators to join us to receive a sweet reminder about your care.
