Washington submits waiver renewal application for Medicaid Transformation Project


Shane Ersland


Washington state health care officials submitted a waiver renewal application for the Medicaid Transformation Project (MTP) Friday.


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The MTP is Washington’s Section 1115 Medicaid demonstration waiver, which is an agreement between the state’s Health Care Authority (HCA) and CMS. It allows the state to implement new policies and use federal Medicaid funds to improve Apple Health, the state’s Medicaid program. 

“Through MTP, our state is focusing on whole-person care through integrated care and coordination with community services, such as housing, employment, and more,” Gov. Jay Inslee wrote in the MTP renewal application. “Washington has also leveraged a broad, collaborative regional approach to building healthier communities through Accountable Communities of Health.”

The current MTP waiver is set to end on Dec. 31st. If CMS approves Washington’s renewal application, the MTP will continue for another 5 years. 

If approved, the MTP will continue to develop innovative projects, activities, and services for Apple Health. The new application also requests expanding state Medicaid programs, including:

  • The Long-term Services and Supports (LTSS) program for Washington’s aging population and family caregivers who provide care for their loved ones. The program would expand to include rental subsidies, coordinated personal care, guardianship and decision-making supports, and presumptive eligibility. It would provide more support and services for aged, blind, and disabled adults who are applying for and receiving home and community-based services.
  • The Foundational Community Supports (FCS) program to help people with complex care needs find stable housing and employment. It would expand the program’s age requirement to those 16 and older so youths exiting foster care can receive supporting housing services. It would also expand the eligibility criteria for those eligible for supported employment services, including people exiting a correctional facility or those who are on parole.
  • The Substance Use Disorder (SUD) program to help people with an SUD receive treatment and inpatient services at institutions for mental diseases (IMD). It would expand to provide contingency management for qualifying adults.
  • The Mental Health IMD program to help people with a mental health issue receive treatment and inpatient services at an IMD.

“Over the past 5 years, MTP has focused on transforming the health care delivery system to improve outcomes and increase equitable access for Medicaid enrollees across the state,” wrote state Medicaid Director Dr. Charissa Fotinos in the renewal application. “This historical federal-state partnership has achieved much for Medicaid beneficiaries by improving and expanding services across Washington, and we have much more work to do together.”

The renewal application also requests CMS approval for new programs, including:

  • The Taking Action for Healthier Communities (TAHC) program, which would focus on developing and implementing community hubs and health-related services, health equity, and community-based workforce needs. Program officials would work with tribes to develop and implement similar services tailored to Native communities.
  • Continuous Apple Health enrollment for children, where kids in Apple Health would not have breaks in coverage because of changes in income through their 6th birthday.
  • Re-entry coverage for continuity of care, where people exiting a correctional or treatment facility have health care coverage immediately upon reentering the public.
  • Apple Health postpartum coverage extension, where people have health care coverage for 12 months after their pregnancy ends.
  • Washington Integrated Care Assessment (WA-ICA), which helps assess a provider or clinic’s level of integration for physical and behavioral health care.

HCA hopes for a CMS response to its renewal application in late 2022.