SB 5372
In CommitteeSenate
Medicaid access program
Creating the medicaid access program.
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 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.
Pro/Con Analysis
Stronger case for concerns
Potential Benefits (4)
Medicaid enrollees—especially low-income adults, children, seniors, and people with disabilities—may benefit from improved provider access due to higher reimbursement, potentially reducing wait times and improving continuity of care.
HealthcarePeopleRef: Sec. 6(1); Sec. 5(2)(a)Medicaid providers (especially solo practitioners and small clinics) may see improved reimbursement rates—up to Medicare levels—for covered professional services, potentially increasing provider participation and reducing patient access barriers.
HealthcarePeopleRef: Sec. 6(1); Sec. 3(1)(c)Federal approval is required before assessments begin, and the bill explicitly preserves actuarial soundness and federal compliance requirements, reducing risk of program failure or legal liability.
Public SafetyRef: Sec. 2(2)(a); Sec. 7If federal rules are violated, the state may be required to repay the federal government, and providers may be liable for refunds—potentially straining state finances and creating administrative burdens for local health jurisdictions.
Local GovernmentPeopleRef: Sec. 5(2)(d); Sec. 2(2)(c)
Potential Concerns (5)
Health insurers and Medicaid MCOs face new annual per-member assessments ($0.50 and $18 respectively), which increase operating costs and may lead to reduced investment, hiring, or premium increases passed to employers and individuals.
Business & EmploymentLean industryRef: Sec. 3(2)(a), (b); Sec. 4(1)Medicaid providers (especially solo practitioners and small clinics) may see improved reimbursement rates—up to Medicare levels—for covered professional services, potentially increasing provider participation and reducing patient access barriers.
HealthcarePeopleRef: Sec. 6(1); Sec. 3(1)(c)Medicaid enrollees—especially low-income adults, children, seniors, and people with disabilities—may benefit from improved provider access due to higher reimbursement, potentially reducing wait times and improving continuity of care.
HealthcarePeopleRef: Sec. 6(1); Sec. 5(2)(a)Federal approval is required before assessments begin, and the bill explicitly preserves actuarial soundness and federal compliance requirements, reducing risk of program failure or legal liability.
Public SafetyRef: Sec. 2(2)(a); Sec. 7If federal rules are violated, the state may be required to repay the federal government, and providers may be liable for refunds—potentially straining state finances and creating administrative burdens for local health jurisdictions.
Local GovernmentPeopleRef: Sec. 5(2)(d); Sec. 2(2)(c)
Who Is Most Affected
Medicaid enrollees—especially low-income adults, children, seniors, and people with disabilities—are likely to see improved access to care if more providers accept Medicaid due to higher reimbursement. This is especially meaningful for populations facing provider shortages or long wait times.
Small- and medium-sized health insurers and MCOs face new per-member assessments, but the $0.50 and $18 rates are relatively modest, and the 36:1 MCO-to-carrier ratio is designed to limit burden on smaller carriers. However, MCOs with large Medicaid populations may see margin compression, especially if they cannot pass costs to employers or state contracts.
MCOs face a $18 per-member assessment, which is substantial relative to typical Medicaid capitation payments. This may reduce their net revenue unless offset by higher state payments or rate adjustments—though the bill explicitly preserves actuarially sound rate-setting standards, limiting upside for MCOs.
Providers serving Medicaid patients—especially primary care physicians, behavioral health clinicians, and community clinics—stand to benefit significantly from reimbursement increases up to Medicare levels, potentially improving financial sustainability and recruitment in underserved areas.