5 Things Washington: PBM regulation, Reproductive health in the legislature, Medicaid redeterminations


Eli Kirshbaum


This month’s edition includes coverage of various health legislation being considered in the legislature and input from Amerigroup Washington on their preparation for Medicaid redeterminations.

Thanks for reading, and happy Friday!


Eli Kirshbaum
State of Reform

1. Lawmakers hope to strengthen nurse workforce

In response to the ongoing nursing shortage, we’re monitoring two bills that aim to augment Washington’s nurse workforce. SB 5498 would establish the Nurse Loan Repayment Assistance Program, through which employers and the state would both help pay tuition costs for nurses. SB 5582 would create more nursing education opportunities at colleges and the Department of Veterans Affairs. Both bills await Senate floor votes.

Lawmakers are also considering a bill that would add Washington to the 37 states who are members of the interstate nurse licensure compact. Advocates, like Democratic bill sponsor Sen. Mullet, say the bill would benefit the nurse profession by incentivizing out-of-state nurses to practice in Washington. But opponents, like the Washington State Nurses Association, argue such an agreement could lead to safety concerns for patients.


2. Bill that would strengthen reproductive rights in constitution sparks debate

A bill that would strengthen reproductive rights in Washington’s constitution sparked debate last month during a Senate Health and Long Term Care Committee meeting. Senate Joint Resolution 8202 would ensure the state wouldn’t interfere with an individual’s reproductive freedom decisions, including the fundamental right to an abortion.

Gov. Jay Inslee testified to support the bill, and said he did not believe “any legislator has the right to order any woman in the state to undergo a forced pregnancy.” Conservative Ladies of Washington President Julie Barrett testified in opposition, claiming that amending the constitution would say it is, “OK to take the life of another human being.” The bill would need some GOP support in order to be enacted, as it would need to be passed by a two-thirds majority in both houses of the legislature.


3. What They’re Watching: Charissa Fotinos, MD, Washington State Health Care Authority

In this edition of “What They’re Watching,” Charissa Fotinos, MD, Medicaid director for the Washington State Health Care Authority (HCA), said preparing for the approaching unwind of the public health emergency is a primary focus of the HCA. “The public health emergency is not ending, but we received information from the federal government that we need to start thinking about redetermining people’s ability to stay on Medicaid,” she said. “We want to make sure no one loses coverage.”

Fotinos also discussed the importance of Washingtonians’ behavioral health needs and her priorities on that front. “There is a lot of work on the 988 crisis system build-up and response. I think there is a lot of discussion on the need to focus on overdose deaths, particularly related to fentanyl. A huge issue is focusing on children’s mental health, and how to support them. Behavioral health impacts all of us.”


4. Amerigroup Washington prepares for Medicaid redeterminations

With preparations underway for Medicaid eligibility redeterminations on April 1st, Medicaid-offering health plans like Amerigroup Washington are working hard to ensure Washingtonians don’t lose their coverage if they’re determined ineligible. CEO Anthony Woods told State of Reform that a key part of the process is making sure health information can be efficiently exchanged. “HCA has the keys to the kingdom on that,” Woods said. “So utilizing [HCA] around data is key.”

Amerigroup has been regularly meeting with HCA to update customer information and raise awareness about coverage options. With about 29,000 of the health plan’s members expected to be affected, Amerigroup implemented their “Ready, Set, Renew” program to provide needed information to enrollees. Woods said they’ve also launched an AI-based Health Compass Program, “an intelligent micro-site that gets a person through the eligibility process.”


5. Other health bills we’re watching

Lawmakers recently held a hearing on a bill that would require health plans to cover fertility services in the state. “Every leading healthcare organization now recognizes infertility as a disease, and does not consider it to be elective,” Pacific Northwest Fertility’s Dr. Lori Marshall testified. “Diseases should be covered by insurance. Despite this, millions of Washingtonians pay insurance premiums for plans that cover neither the diagnosis nor the standard treatment of this disease.”

Legislators are also debating several bills aiming to reign in allegedly discriminatory practices from pharmacy benefit managers. This includes a bill to limit practices such as requiring patients to obtain their prescriptions from mail-order pharmacies and refusing to pay for provider-recommended medications because they come from a wholesaler or pharmacy. Another bill would require insurers to calculate enrollees’ cost sharing obligations in an effort to reduce increasing prescription drug prices.