Increasing Medicaid reimbursement rates is WSMA’s top legislative priority


Shane Ersland


The Washington State Medical Association’s (WSMA) top priority this legislative session is to secure an increase in Medicaid reimbursement rates for professional healthcare services.


Stay one step ahead. Join our email list for the latest news.



The WSMA is requesting that legislators improve access to care for Washingtonians enrolled in Medicaid by supporting an increase in Medicaid reimbursement rates for services delivered by physicians, physician assistants, and advanced practice nurse practitioners to the equivalent paid by Medicare, and adjusting rates to inflation moving forward. 

WSMA President Katina Rue, DO, told State of Reform that the proposal’s fiscal impact for the 2023-25 biennium would be $200.4 million in general funds, leveraging a more than two-to-one federal match for an overall investment of $634.8 million.

“That’s a huge ask for us,” Rue said. “But because reimbursement rates are so low, it’s a necessary request making the Medicaid reimbursement amount up to the Medicare amount, and then increasing that year after year with inflation.” 

WSMA conducted a survey amongst members to gauge their financial concerns, and found that many physicians were worried that they would not be able to afford to continue caring for Medicaid patients due to reimbursement rates not covering the cost of care, Rue said.

“That went out through our policy department, asking them how their financial outlook was, and how concerned they were with their ability to care for Medicaid patients,” she said. “Physicians are ready to say ‘no’ to Medicaid patients altogether. Practices are dropping the percentage of Medicaid patients they are seeing, and we have more folks covered by Medicaid than ever before.”

Medicaid added 400,000 enrollees during the COVID-19 pandemic, and now covers more than 2.2 million residents, which is nearly 30% of Washingtonians

Washington receives the lowest federal contribution for Medicaid rates, and only two states reimburse specialty services at lower rates. When a state allocates funds toward Medicaid reimbursement, the federal government contributes significant matching funds, stretching the impact of state investments. All specialty services are impacted by low Medicaid reimbursements.

“And If we don’t have the specialty services, it’s hard to get folks into practices because reimbursements don’t cover the cost of care,” Rue said.

WSMA is also advocating for House Bill 1357, which would modernize the prior authorization process. The bill would require insurance carriers to post prior authorization requirements, evidence, and criteria online, and make it available to patients and physicians to promote transparency. When physicians recommend a service or a drug for a patient, health insurance coverage is often conditioned on prior authorization from a patient’s insurance carrier.

HB 1357 passed in the House on March 4th, and was scheduled for an executive session in the Senate Committee on Health and Long Term Care on Thursday.

“The prior authorization bill has been working through negotiations that appear to be going well, in that we feel like we have a solution that works for carriers and the physicians doing the work,” Rue said. “We’re hoping that it will pass out of the Senate committee with some amendments, then go for a vote in the full Senate. That was one of our big priority bills.”

WSMA is also supporting numerous reproductive health and abortion access bills, including the “shield law,” which would restrict the ability of other states to use Washington courts and the state’s judicial process to enforce their laws against abortion.

“The shield law is really important, and it’s one I’ve testified on,” Rue said. “Physicians here need to be able to practice without worrying that they’ll be criminalized by another state. It’s much-needed care, so we have to have strong policies protecting our physicians’ ability to give patients that care.”