HB 2100 imposes a tax on large Washington companies for payroll expenses exceeding $125,000 per employee (mirroring the federal Medicare surtax threshold), effective July 2026. The tax revenue will fund the "Well Washington Fund," with 51% of annual revenues dedicated to supporting health care (including Medicaid), higher education, food assistance (SNAP), and energy/housing programs. The bill creates an oversight board of 25 legislative members to manage fund allocations, ensuring resources target services most impacted by federal budget cuts. This policy directly affects large operating companies with significant payroll, aiming to offset projected losses in state services from federal legislation.
HB 1583 requires Washington's Health Care Authority to apply for a federal waiver by September 1, 2025, to expand Medicaid coverage for "traditional health care practices" delivered through specific facilities. These practices include indigenous health knowledge and services provided by Indian Health Service facilities, tribally operated facilities under federal law, or urban Indian organizations. Coverage would be available to Medicaid beneficiaries receiving care at these facilities, but only if the federal Centers for Medicare & Medicaid Services approves the waiver. The bill does not change current Medicaid rules but seeks to add this coverage option through a federal waiver process.
HB 1639 requires Medicare Advantage insurance providers operating in Washington to disclose three specific details to current and potential enrollees: their claims denial rate (as a percentage), the percentage of denied claims later approved on appeal, and the appeals process. These disclosures must be provided before enrollment and upon request after enrollment. The bill states that failing to provide these disclosures violates Washington’s Consumer Protection Act (Chapter 19.86 RCW), classifying such failures as unfair or deceptive practices. This legislation directly affects Medicare Advantage entities serving Washington residents, aiming to increase transparency in coverage decisions.
House Bill 1392 establishes the Medicaid Access Program in Washington state, directly affecting health carriers and Medicaid managed care organizations. The bill implements an annual "covered lives assessment" on these entities, with specific per-member-per-month rates, to fund the program. Implementation of these assessments and the program is conditional upon federal approval from the Centers for Medicare and Medicaid Services, along with state appropriation certifications and contract amendments.
SB 5083 aims to ensure access to primary care, behavioral health, and affordable hospital services for public employees and their dependents in Washington state. It sets caps on how much health carriers can reimburse in-network hospitals for inpatient and outpatient services, generally limiting them to 200% of Medicare rates in 2027 and 190% in 2029, with higher limits for children's specialty hospitals. The bill also mandates minimum reimbursement rates for in-network primary care and non-facility-based behavioral health services (150% of Medicare) and for rural critical access hospitals. Additionally, it requires certain hospitals to contract with health carriers serving public employees and mandates data sharing with the Health Care Authority for monitoring.
SB 5211 authorizes Washington state to pay parents for providing "extraordinary care" to their minor children (under 18) with developmental disabilities, a service currently only available for adult children. The bill requires the state to seek Centers for Medicare & Medicaid Services approval by January 31, 2026, to amend home and community-based waivers allowing parents to be paid as individual providers for care exceeding typical parental duties. Parents would receive payment only for "extraordinary care" defined as services necessary to prevent institutionalization, meeting specific assessment criteria (E or B high classification). This change aims to address caregiver shortages, support family stability, and reduce long-term costs by keeping children in home settings.
HB 1062 requires all health plans in Washington (including commercial plans, public employee coverage, and state Medicaid) to cover biomarker testing starting January 1, 2026. This applies to tests that measure biological markers in tissue or blood (like gene mutations) when used for diagnosis, treatment, or monitoring of a patient’s condition, provided the test is supported by FDA approvals, Medicare guidelines, clinical practice standards, or expert consensus. Plans must ensure coverage without causing unnecessary disruptions, such as requiring multiple biopsies. The bill mandates this coverage uniformly across all plan types under specific evidence-based criteria.
HB 1603 requires insurers to offer Medicare supplemental (Medigap) coverage without health-based denial to Washington residents who voluntarily leave a Medicare Advantage plan (Part C) and switch to Original Medicare (Parts A and B). The bill mandates that eligible individuals - specifically those who disenroll from Medicare Advantage and enroll in Parts A/B - must be guaranteed access to a Medigap plan within 63 days of disenrollment, provided they submit proof of termination. This applies to all insurers offering Medigap plans to new enrollees, prohibiting discrimination based on health status or preexisting conditions during this transition window. The policy directly affects seniors switching from Medicare Advantage to Original Medicare, ensuring they can maintain supplemental coverage without barriers. The bill amends Washington’s RCW 48.66.055 to codify this "guaranteed issue" requirement under subsection (3)(b)(E).
Senate Joint Memorial 8002 is a resolution from the Washington State Legislature to the federal government concerning Medicare. It expresses opposition to Medicare privatization and urges federal action to create a more equitable system between Original Medicare and private Medicare Advantage plans. The memorial specifically requests the federal government to eliminate Original Medicare's 20 percent copays, add benefits like dental and vision, cap out-of-pocket medical expenses, and eliminate excessive administrative costs and profits within Medicare Advantage. It also seeks to recoup funds from documented overpayments and fraud in Medicare Advantage programs to support a stronger Original Medicare system for seniors and disabled beneficiaries.
HB 1076 establishes a structured process for Washington State’s health technology assessment program, directly affecting state health programs (like Medicaid) that decide which medical technologies qualify for coverage. The bill requires the state to systematically review health technologies prioritized based on Medicare coverage, expert guidelines, safety concerns, high costs, or significant usage variations, with up to eight reviews annually. Key provisions mandate evidence-based assessments of safety, efficacy, and cost-effectiveness - considering patient input and unique impacts on populations (e.g., age, disability) - and require decisions within 180 days of submission. The program must align with federal Medicare decisions unless new evidence supports a different conclusion, ensuring transparency through public comment and written explanations for denied requests.
