SHB 1392
SignedHouse
Medicaid access program
Creating the medicaid access program.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill creates the Medicaid Access Program to raise Medicaid provider payment rates for professional services toward Medicare levels, funded by assessments on health insurers and Medicaid managed care organizations. It requires federal approval before implementation and includes a sunset if approval is not received by January 1, 2027.
- Creates the 'Medicaid Access Program' to increase Medicaid provider payment rates for professional services (e.g., office visits, surgery, behavioral health) up to Medicare rates, adjusted annually for inflation.
- Imposes annual assessments on health carriers ($0.50 per covered life per month) and Medicaid managed care organizations ($18 per covered life per month), with a 36:1 ratio of MCO to carrier assessments, capped at 3 million member months each.
- Requires federal approval (via CMS state plan amendments or waivers) before assessments begin; if approval is not received by January 1, 2027, the program expires.
- Establishes a dedicated 'Medicaid Access Program Account' in the state treasury to collect assessments and disburse funds to providers and MCOs for increased payments.
- Adds the Medicaid Access Program Account to the list of accounts eligible to receive a share of state treasury investment earnings, based on average daily balance.
Who is affected
- Health carriers (insurance companies) — Health insurance companies (health carriers) that sell fully insured group or individual plans in Washington must pay an annual assessment of $0.50 per covered life (member per month), up to 3 million member months per carrier, and submit reporting data.
- Medicaid managed care organizations — Medicaid managed care organizations must pay an annual assessment of $18 per covered life (member per month), up to 3 million member months per organization, and submit reporting data.
- Health care providers — Health care providers who serve Medicaid patients (e.g., doctors, clinics, hospitals) may receive higher payment rates for covered professional services—potentially up to Medicare rates—if the program is fully implemented and funded.
- Medicaid enrollees — Medicaid enrollees may benefit from improved access to care if higher provider payment rates lead to more providers accepting Medicaid.
- State of Washington (fiscal operations) — The state treasury and general fund will receive interest earnings previously allocated to the general fund, as this bill adds the new Medicaid Access Program account to the list of accounts eligible for a share of investment earnings.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Increases Medicaid provider payment rates for professional services toward Medicare levels, which—when fully implemented—would significantly improve provider participation, reduce patient access barriers, and improve continuity of care for Medicaid enrollees, especially for behavioral health, surgery, and primary care services.
HealthcarePeopleRef: Sec. 6(1)Expands rate increases to include high-need service categories (e.g., opioid treatment programs, low-level behavioral health, maternity services), directly improving access for vulnerable populations (e.g., people with substance use disorders, pregnant Medicaid enrollees) who currently face severe provider shortages.
HealthcarePeopleRef: Sec. 6(1), Sec. 6(2)Creates a dedicated funding stream (Medicaid Access Program Account) to support provider rate increases, reducing reliance on general fund appropriations and enhancing program stability—benefiting providers who currently face unpredictable funding cycles and chronic underpayment.
HealthcarePeopleRef: Sec. 5(2)(a), Sec. 6(1)Aligns Medicaid payment rates with Medicare levels (adjusted for inflation), narrowing the payment gap that contributes to provider reluctance to accept Medicaid patients—potentially increasing provider participation and reducing geographic and demographic disparities in access.
HealthcarePeopleRef: Sec. 2(2)(a), Sec. 6(1)Allows MCOs to use program funds to cover the nonfederal share of increased capitation payments, supporting state matching requirements and improving federal funding leverage—though this is a technical accounting feature, it helps maintain program viability under federal cost-sharing rules.
HealthcareLean peopleRef: Sec. 5(2)(b)
Potential Concerns (5)
Imposes significant assessments on health insurers ($0.50/member/month) and Medicaid MCOs ($18/member/month), capped at 3 million member months each—effectively shifting costs to health plans, which may reduce profitability or lead to premium increases for employer-sponsored or individually purchased plans not covered by Medicaid.
Business & EmploymentLean industryRef: Sec. 3(2)Creates a regressive cost structure: assessments are capped per organization (3M member months), meaning large MCOs and insurers pay less per covered life than smaller ones, and the 36:1 carrier-to-MCO ratio disproportionately burdens MCOs—potentially destabilizing smaller or financially weaker MCOs, which could reduce provider network stability and access.
Business & EmploymentIndustryRef: Sec. 3(2), Sec. 3(6), Sec. 4(5)Requires certification by the Office of Financial Management that appropriations fully support increased provider rates—introducing fiscal uncertainty and potential delays if state revenue projections falter, which could delay or reduce provider payments regardless of federal approval.
Local GovernmentLean industryRef: Sec. 2(2)(c)Adds the Medicaid Access Program Account to the list of accounts eligible for investment earnings—reallocating a share of state investment returns from the general fund to this account, which slightly reduces general fund revenue available for other public services (e.g., education, transportation) without a direct offset.
Local GovernmentRef: Sec. 12 & 13 (amending RCW 43.84.092)Program implementation is contingent on federal approval and includes a hard sunset if approval is not received by January 1, 2027—introducing uncertainty for providers and enrollees and potentially wasting administrative resources if federal approval is denied or delayed.
Public SafetyRef: Sec. 2(2)(a)
Who Is Most Affected
Medicaid enrollees—especially those in rural areas, people with behavioral health needs, and those relying on specialists—are most likely to benefit from improved provider access and continuity of care if the program is fully implemented. However, if federal approval is denied or assessments destabilize MCOs, access could worsen.
Healthcare providers (especially solo practitioners, small clinics, and behavioral health specialists) stand to gain significantly from higher, more predictable payments—potentially improving financial sustainability and willingness to accept Medicaid patients. However, they may face administrative burdens if assessments trigger MCO network restrictions.
Large health insurers and MCOs with >3M member months face capped assessments, reducing per-member costs; smaller MCOs and insurers may face disproportionate burdens, potentially leading to consolidation or reduced provider networks. Overall, the structure favors large, well-capitalized plans.
The state general fund loses a small but meaningful share of investment earnings due to the reallocation to the Medicaid Access Program Account. While the bill claims no direct cost to the general fund, the opportunity cost of lost investment income reduces flexibility for other public priorities.
Local governments (e.g., counties operating public health or behavioral health programs) may benefit indirectly from improved provider networks and reduced uncompensated care, but could face strain if MCOs reduce provider networks or if federal approval delays program rollout.