WA: Agencies brief legislators on Medicaid transformation

OLYMPIA — State legislators continue to raise concerns over the function and sustainability of Washington state’s move towards full integration for Medicaid physical and behavioral health. The Joint Select Committee on Health Care Oversight held a work session on Wednesday to receive an update on the Health Care Authority and DSHS’ progress towards submitting an 1115 Medicaid waiver to CMS. Presenters included HCA’s Medicaid Director MaryAnn Lindeblad, Chief Policy Officer Nathan Johnson, as well as DSHS’ Home and Community Services Director Bea Rector and Office of Service Integration Chief Candice Goehring. Legislators spent much of the time questioning staff around several areas of concern:

  • Long-term sustainability
  • Systems overlap
  • Housing and employment support
  • Accountable Communities of Health (ACH)
Source: leg.wa.gov

Source: leg.wa.gov

The 1115 Medicaid waiver exempts states from traditional federal Medicaid funding restrictions. This allows for demonstration projects that encourage innovative policies. The HCA and DSHS have spent much of the past two years building towards a waiver that would allow for Medicaid funds to be spent on various non-traditional services for fully integrated care.

The Committee is Co-Chaired by Senator Randy Becker (R-Eatonville) and Representative Eileen Cody (D-Seattle). Committee members spent much of the work session getting up to speed on progress towards submitting the waiver application. Once briefed, consistent themes of concern developed. Senator Karen Keiser (D-Federal Way) and Senator Steve Conway (D-Tacoma) were especially concerned ACHs would interact with other state, local, and federal agencies. According to Nathan Johnson, Accountable Communities of Health are intended to incorporate all relevant programs and interests together in order to create solutions that meet regional needs. He did admit that the varying nature of government agency regions means that not every ACH will be a perfect fit geographically.

Senator Linda Evans Parlette (R-Wenatchee) raised concerns over the long-term sustainability of Medicaid transformation. She asked whether a cost sharing model akin to the now eliminated Basic Health program is being considered. Johnson replied that additional cost sharing for Medicaid members had not been included but that it could be considered outside of the waiver process.

Source: leg.wa.gov

Source: leg.wa.gov

MaryAnn Lindeblad also discussed the need to incorporate housing and employment support for those enrolled in Medicaid, and how the waiver can help in this effort. This sparked the interest of a few committee members. Sen. Conway was interested in specifics on how these services would work. He also encouraged the HCA and DSHS to incorporate ongoing efforts by the Department of Labor and Industries to integrate health care support with its employment programs.

The HCA and DSHS will spend the rest of the summer gathering stakeholder feedback before the formal submission of the application in the fall.