HB 1521
In CommitteeHouse
Complex care serv./children
Supporting caregivers who provide complex care services to children with heightened medical needs.
This status may be delayed. See Action History below for the latest updates.
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 allows Washington’s Medicaid program to pay for complex medical care services provided at home by trained family members (like parents or guardians) for children under 18 with significant health needs. It sets training standards, ensures agencies cover training costs, and bases eligibility only on the child’s income.
- Starting September 1, 2026, the state will pay home health agencies for complex care services provided by trained family caregivers (e.g., parents, guardians) to children under 18 receiving Medicaid-funded private duty nursing.
- Caregivers must complete at least 75 hours of training from an accredited agency and be deemed competent by a registered nurse before providing services.
- Caregivers can switch employers without repeating training, and home health agencies must cover all training costs — they cannot charge caregivers for it.
- Eligibility for these services will be based only on the child’s income, not household income — making it easier for some families to qualify.
- The state must submit a report by September 1, 2029 evaluating the program’s effectiveness using existing data, without requiring new reporting from agencies.
- The state will seek federal approval (via a state plan amendment or waiver) to implement the new payment model under Medicaid rules.
Who is affected
- Parents, guardians, and other close family caregivers of children with complex medical needs — Families and caregivers of children under 18 with significant medical needs who rely on complex care services at home — this bill allows them to be paid for providing such care through a home health agency, after completing approved training.
- Home health agencies licensed under chapter 70.126 RCW — Home health agencies that employ trained caregivers to provide complex care services — they must cover training costs and ensure caregivers meet state and federal training standards.
- Children with heightened medical needs enrolled in Medicaid — Children under 18 who receive private duty nursing through Washington’s Medicaid (Apple Health) program — this bill expands access to home-based care by enabling family caregivers to be compensated for complex care tasks.
- Washington State Department of Health — The Washington State Department of Health (referred to as "the authority" in the bill), which administers Medicaid and must implement training standards, approve accreditors, and report on program outcomes.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (4)
This bill enables children under 18 with complex medical needs to receive high-quality, home-based care from trained family members—reducing hospitalizations, ER visits, and institutional placements. Family caregivers who know the child’s routines and preferences can provide more consistent, emotionally supportive care, directly improving health outcomes and quality of life. The requirement that caregivers be employed by licensed agencies and supervised by RNs ensures clinical oversight and safety, preserving the integrity of care delivery.
HealthcarePeopleRef: Sec. 1(1)(a), (d)By covering 100% of training costs and allowing credential portability (Sec. 1(3)–(4)), the bill removes financial and logistical barriers for family caregivers—especially low- and middle-income parents—who might otherwise forgo paid work to avoid out-of-pocket training fees or time-intensive retraining when switching agencies. This supports caregiver retention and labor mobility, directly increasing household income stability.
FinancialPeopleRef: Sec. 1(1)(b), (3), (4)Allowing eligibility based only on the child’s income (not household income) helps families where the child has minimal income (e.g., a newborn or child receiving SSI) but lives in a household with higher overall earnings—such as dual-income families or those with non-custodial relatives. This prevents penalizing families for living together and expands access to critical services for families who might otherwise be disqualified due to technical household income thresholds.
HousingPeopleRef: Sec. 1(5)Requiring RN delegation and oversight of complex tasks (e.g., tracheostomy care, medication administration) ensures clinical safety and reduces the risk of adverse events at home. This protects not only the child but also siblings and household members by minimizing the chance of infection, falls, or medication errors—enhancing community-level public health and safety.
Public SafetyPeopleRef: Sec. 1(1)(c), (8)
Potential Concerns (3)
By basing eligibility solely on the child’s income (not household income), the bill may expand access for some low-income families—but this narrow eligibility criterion could unintentionally exclude many families whose overall household income is too high to qualify for Medicaid, even if the child’s individual income is low. This creates a gap where middle-income families with a child requiring complex care fall through the cracks, as they earn too much for Medicaid but cannot afford private duty nursing out-of-pocket. This misalignment between eligibility criteria and real-world household economics reduces the bill’s overall reach and fairness.
FinancialPeopleRef: Sec. 1(5)The requirement that home health agencies absorb all training costs (Sec. 1(4)) may strain small agencies with thin margins, especially if reimbursement rates do not fully cover the $20–$30/hour wage cost of training time plus instructor overhead. While agencies are reimbursed by the state, upfront cash flow and administrative burden could fall disproportionately on smaller providers, potentially reducing participation and limiting caregiver availability in rural or underserved areas.
Business & EmploymentPeopleRef: Sec. 1(4)The state-mandated reporting requirement (Sec. 1(7))—though explicitly stating agencies need not submit new data—still requires the Department of Health to analyze existing administrative data and produce a comprehensive evaluation report by 2029. This creates an unfunded mandate on state staff time and resources, diverting attention from other high-priority health system oversight tasks, especially during a period of broader Medicaid expansion pressures.
Local GovernmentPeopleRef: Sec. 1(7)
Who Is Most Affected
Low- and middle-income parents/guardians of children with complex medical needs benefit significantly: they gain paid employment while caring for their child, avoid out-of-pocket training costs, and keep their child in a familiar home environment—reducing stress and improving outcomes. However, families with incomes just above Medicaid thresholds may still be excluded due to the narrow income-only eligibility rule.
Larger, well-capitalized home health agencies stand to gain new revenue streams from state reimbursement for complex care services. However, smaller agencies may struggle with upfront training costs and administrative burden, especially if reimbursement rates lag behind actual labor and overhead costs. The portability of training reduces barriers to caregiver mobility, potentially increasing competition among agencies.
Children with complex medical needs benefit most directly: they receive care from trusted caregivers in their homes, reducing trauma, hospitalizations, and institutionalization. However, those in households with higher combined incomes may be excluded due to the narrow income-only eligibility criterion, limiting access for some middle-class families.
The Department of Health gains authority to standardize training and oversight but faces new administrative burdens—including accrediting organizations, managing provider agreements, and producing a report by 2029. While the bill avoids imposing new data collection on agencies, the state must still allocate staff time and analytical resources, potentially diverting attention from other Medicaid oversight priorities.