SB 5372

In Committee

Senate

Medicaid access program

Creating the medicaid access program.

Introduced (completed)
2
Committee (current stage)
3
Floor Vote (not started)
4
Opposite Chamber (not started)
5
Governor (not started)
6
Signed (not started)

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.

Introduced: January 19, 2025

Last Action: January 12, 2026

Status: S Health & Long-

Companion Bill: #1392

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AI Analysis

This analysis was generated by AI and may contain errors. It is not legal advice. Always refer to the official bill text for authoritative information.

People & CommunitiesBalancedCorporate & Wealthy Interests

This bill creates the Medicaid Access Program to raise Medicaid provider payment rates for certain services up to Medicare levels, funded by assessments on health insurers and Medicaid managed care organizations. It requires federal approval before assessments begin and includes specific rules for collecting, managing, and distributing funds.

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.
Imposes annual assessments on health carriers ($0.50 per covered life) and Medicaid managed care organizations ($18 per covered life), with a 36:1 ratio of MCO to carrier assessments.
Requires federal approval (via CMS) before assessments begin; assessments are conditional on CMS approval of state plan amendments or waivers.
Establishes a dedicated "Medicaid Access Program Account" in the state treasury to collect assessments and pay for provider rate increases, administrative costs, and refunds.
Sets a 2027 start date for rate increases (beginning January 1 of the second plan year after federal approval), with annual inflation adjustments using the Medicare Economic Index.

Who is affected

Health insurance companies (health carriers) — 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, up to 3 million member months per carrier.
Medicaid managed care organizations — Medicaid managed care organizations must pay an annual assessment of $18 per covered life (up to 3 million member months per organization), and may see changes to how they’re paid for providing Medicaid services.
Health care providers (e.g., physicians, clinics, hospitals) — Doctors and other health care providers who treat Medicaid patients may receive higher payments for certain services—up to Medicare rates—for services like office visits, surgery, behavioral health, and more—starting in 2027 (if federal approval is obtained).
Medicaid enrollees — Medicaid enrollees may benefit from improved access to care if providers receive higher reimbursement rates, potentially leading to more providers accepting Medicaid.

Effective: January 20, 2025Fiscal impact: The bill creates a new "Medicaid Access Program" funded by assessments on health carriers ($0.50 per member per month) and Medicaid managed care organizations ($18 per member per month), with a 36:1 ratio of MCO to carrier assessments. These funds will be used to increase Medicaid provider payment rates for certain services up to Medicare levels. There is no direct general fund cost, but the state may need to repay the federal government if federal rules are violated.Sunset: January 1, 2027 (if federal approval not received by that date)

Model: Intel/Qwen3-Coder-Next-int4-AutoRoundGenerated: Mar 19, 2026, 8:53 PM

Pro/Con Analysis

Potential Benefits (3)

Increasing Medicaid provider payment rates for professional services up to Medicare levels will likely improve access to care for Medicaid enrollees by incentivizing more physicians and specialists to accept Medicaid patients, reducing barriers for low-income Washingtonians.
HealthcarePeopleRef: Section 6(1), Section 6(2)
The rate increases specifically target high-need service categories such as emergency room, inpatient/outpatient surgery, behavioral health, and maternity services, which are critical for the health and safety of vulnerable populations who rely on Medicaid.
HealthcarePeopleRef: Section 6(2)
By aligning Medicaid rates with Medicare rates, the bill helps stabilize the healthcare workforce in Washington by reducing the financial disparity between treating Medicare and Medicaid patients, which may help retain providers in the state.
HealthcarePeopleRef: Section 6(1)

Potential Concerns (4)

The bill imposes a new $0.50 per member per month assessment on fully insured health plans, which is likely to be passed through to consumers in the form of higher premiums for private health insurance.
HealthcareLean industryRef: Section 3(1)(ii), Section 3(2)(b)
Medicaid managed care organizations face a significant new cost burden of $18 per member per month, which may lead to reduced margins, potential service cuts, or increased administrative costs that could destabilize the Medicaid managed care market.
Business & EmploymentIndustryRef: Section 3(1)(i), Section 3(3)
The entire program is contingent on federal CMS approval, creating significant uncertainty; if approval is delayed or denied, the state incurs administrative costs without delivering the promised provider rate increases, potentially leaving providers in a state of financial limbo.
Public SafetyLean industryRef: Section 2(2), Section 18
If the program is later deemed non-compliant with federal law, the state must repay the federal government, and providers may be required to refund payments, creating a financial risk for both the state treasury and healthcare providers who have already received the funds.
FinancialLean industryRef: Section 5(2)(d)

Who Is Most Affected

Healthcare Providers (Physicians, Clinics, Hospitals)Positive Impact
As the primary beneficiaries of the rate increases, providers will see improved reimbursement for services, potentially allowing them to expand Medicaid panels and improve financial stability.
Medicaid EnrolleesPositive Impact
Enrollees will benefit from improved access to care as more providers are willing to accept Medicaid, leading to better health outcomes and reduced barriers to receiving necessary medical services.
Medicaid Managed Care OrganizationsNegative Impact
These organizations face a substantial new assessment of $18 per member per month, which will significantly impact their operating costs and may require them to adjust their service offerings or pricing strategies.
Health Insurance Companies (Health Carriers)Negative Impact
Private health insurers will pay a $0.50 per member per month assessment, which will likely be passed on to consumers in the form of higher premiums, affecting the affordability of private health insurance.
State Government Agencies (Health Care Authority, Insurance Commissioner)Mixed Impact
The Washington State Health Care Authority and Insurance Commissioner will take on new administrative responsibilities for assessing, collecting, and managing the new program, increasing their workload and operational complexity.