We are entering the third week of the 2023 legislative session. With 90 days remaining, legislative leaders continue to set the stage on priorities by holding work sessions and public hearings on the issues that will dominate the agenda in Olympia this year. The development of the state’s two-year operating budget is also a priority.
Our focus this week has been to work with proponents on introducing skilled nursing facility payment legislation, and on developing the budget proviso language that will drive our priorities in the state operating budget.
2023-2025 Budget Priorities
Every sector of long term care is bearing the brunt of a hypercompetitive labor market, unprecedented inflation, and the impact of being at the epicenter of a public health emergency that has increased regulatory and operating requirements and costs. However, the Legislature is hearing similar concerns across all types of occupations from manufacturers to hospitality to educational providers. Unlike some who can replace workers with kiosks or other technology, long term care worker shortages must be addressed by raising up a workforce through competitive wages, reducing barriers to entry such as training and certification programs, and by renewing the value for long term care services and supports with society. We continue to focus on the vulnerable residents who need us, the upstream impacts to hospital discharge when we don’t have staff for our long term care beds, and the fact that our long term care residential settings are part of the state’s housing solution for impoverished elderly individuals who need personal care. We are focused on meeting with key budget leaders in the coming weeks and will keep you apprised of the status of our budget work. Both the House and Senate will release budget proposals in the next month.
Skilled Nursing Facility legislation was introduced today SB 5526, legislation to address nursing home Medicaid funding, was introduced. Sponsored by Senator Kevin VanaDe Wege (D-24) and co-sponsored by Senator Ron Muzzall (R-10), the legislation is intended to make structural rate fixes and address workforce funding. Current skilled nursing facility payments lag by over $100 million and are based on costs from 2020. The legislation requires that skilled nursing facility rates are updated more frequently, and that worker funding is continued from last year. The legislation also adjusts the occupancy penalty assessment and establishes ongoing funding levels for worker wages.
We are seeking additional funding support for specialized care to support more timely admissions to skilled nursing facilities from hospitals. An additional $4.9 million general fund state would support rate add-ons for enhanced behavioral services ($175/day), ventilator care ($192/day), tracheotomy care ($123/day), and services for those with traumatic brain injuries ($200/day).
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 continue our work on budget language to drive nearly $130 million in state funding for base rates, specialized dementia care, and enhanced care services contracts. Adequate Medicaid funding is the key to opening access for low-income citizens to this setting.
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. They provide a less restrictive setting for people who have severe behavioral diagnoses and need long term care, but do not need psychiatric hospital care.
Last week I met with Representative Nicole Macri (D-43), vice chair of the House Appropriations Committee and member of the House Health Care Committee. She is interested in how providers can serve difficult-to-place hospital residents and help address our state’s hospital discharge issues. I also met with legislative staff to talk through policy options.
There is a terrible human cost when people cannot access care settings that provide the appropriate supports for their specific care needs, and there is an inseparable connection between Medicaid funding and access to long term care with qualified support staff. WHCA’s budget priorities are critical to ensuring people with complex health needs are not waiting in limbo in medical hospitals while we have providers fully prepared with qualified staff to support them in the community.
Housing and Workforce Dominate Legislative Agendas
While the 2023-25 state operating budget is a high priority, housing and workforce shortages are among the overshadowing issues that will shape the two-year state spending plan. Here’s our perspective on both:
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Long term care is a housing solution for low-income seniors: For low-income long term care clients and residents in nursing homes and assisted living, an integral component of the care package is housing. For many, there is no option to return to a home with family caregivers who manage complex and advancing care needs. Their homes are the assisted living and skilled nursing centers in which they live and receive care, and their extended families are the caregivers upon whom they rely. It will be important for us to help legislators understand that support for adequate Medicaid funding is a means to house people who do not have other options.
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Inadequate Medicaid funding impacts worker access to housing: Unfortunately, the lack of affordable housing is a problem for the thousands of Washington workers who deliver long term care services and support. Medicaid funding in Washington doesn’t compete with the current cost of labor. That translates to a big problem for Washington long term care providers. It’s difficult to recruit and retain workers when wages are not adequate to cover housing costs, let alone the gas for commuting to work and groceries to feed a family. Investments in Medicaid funding that elevate low wages in long term care are critical this year, and this investment will support workers affected by the rising cost of housing.
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Workforce shortages: While tech companies like Google and Microsoft are announcing worker layoffs, Washington businesses are scrambling to find workers. For health and long term care, there are a number of measures that could help with timely access to credentialed and licensed workers. Adequate Medicaid funding is the foundation for ensuring providers can compete with other business sectors for qualified workers. That funding alone will not address the pipeline problem. One measure that could help is Senate Bill 5499 that directs Washington to join the multistate nurse licensure compact act that would allow licensed and credentialed out-of-state nurses to work in Washington without onerous and timely relicensing requirements. Such legislation has been introduced in the past, with little traction among Democrat leaders, but the timing on the idea may be better, given the critical nature of the workforce challenge.
We continue to advocate for measures that eliminate barriers for workers, including access to online training and testing. There is much to be done in this area.
Policy Round-up
Rent stabilization: There will be multifaceted approaches to addressing housing, including measures that would create rent stabilization and that would increase notification requirements under the Residential Landlord Tenant Act. Two such measures will be subject to public hearing this week in Olympia. House Bill 1389 (and its Senate companion, SB 5435) were introduced last week. The House version of the bill will be subject to public hearing on Tuesday. House Bill 1124 is scheduled for hearing on January 26, and the policy would extend notification requirements for rent increases and would allow tenants to terminate tenancy without penalty for rent increases over 5%. We are assessing the impact of this legislation on our members and will keep you apprised.
Personal Needs Allowance (PNA): HB 1128/SB 5183 increases the personal needs allowance for Medicaid recipients in residential care settings is under consideration. The current personal needs allowance is $75/month. The legislation would increase the allowance to $100/month. Both bills were subject to hearing last week, and both will advance. Proponents include the Long Term Care Ombuds, DSHS, and AARP.
Taxing Senior Meals: HB 1431 was introduced last week and clarifies that meals furnished to tenants of senior living communities as part of their rental agreement are not subject to sales and use tax. Rep. Joe Timmons (D-42) is the prime sponsor for the bill. See issues briefing. We anticipate a hearing on the bill will be held in early February.
