On April 23, 2023 the Legislature adjourned after the 105-day regular session. Thank you for your advocacy work throughout the session—it is incredibly important that legislators understand that you are interested and engaged. We are committed to continued support in the interim and look forward to working with you to connect more powerfully.
Final Budget
The Legislature passed the final operating budget plan for 2023-25 on Sunday. The bill now travels to the Governor’s Office for final consideration. The Legislature’s state operating budget allocates $70 billion in state spending for the two-year cycle. Here is a three-way budget comparison.
For assisted living, the budget drives $170 million in additional funding, including a 15% increase in base Medicaid funding. The plan includes a FY25 rebase in base rates that equates to an increase of about $7/day as well. Specialized dementia care rates are converted to a flat rate add-on of $43.48 per resident day. “Bridge funding” of $20.99 per day is provided for ARC, EARC and AL contracts for care centers where there is a Medicaid census of 90% or greater. The plan also includes a 5% increase for enhanced community services contracted rates.
For enhanced services facilities, the final budget provides a rate increase from $459/day to $596.10/day, and provides $30 million in operating funds for new ESFs and specialized dementia care beds through the Behavioral Health Community Capacity Grants funded in the 2021-23 capital budget. This includes a phase in of 64 ESF beds, and phase-in of 107 additional specialized dementia beds. The budget also requires DSHS to develop a standard process for acute care hospital referrals for difficult to discharge behavior clients to go to ESFs and EARCs with specialty behavioral health contracts. DSHS is required to allow the referrals to go to these providers regardless of whether the individual being referred has involuntary treatment history.
For skilled nursing facilities, the Conference budget drove a total of $406.1 million in additional Medicaid funding, including money for a one-time annual rebase for FY24 and for the statutory FY25 rebase. The current budget dial is $319.82. That moves to $341.41 for FY24, and $364.67 for FY25. The plan includes an inflation adjustment for each year of the biennium (FY24 = 4.7%; FY25 = 5%). Minimum occupancy is established at 80% for FY24 & FY25. The direct care cap was also subject to adjustment (FY24 = 153%; FY25 = 142%). The budget provides that a rate add-on will be allocated to ensure the budget dial from FY25 is carried into the base for the 2025-27 biennium. This means the dollars are built into the four-year Outlook Budget even though the one-time policies will be sunset in two years. Finally, the proposal also includes funding for SNF specialty rates including vent and trach care.
Policy Wrap-Up
There was much positive momentum on workforce issues this session. Additionally, we were successful in our work to ensure that independent senior meals are exempt from taxes, and we helped shape legislation related to nursing pool reporting and transparency. Here are details on the policy bills we’ve been engaged in this session. Some of these initiatives will require rule promulgation—WHCA will be fully engaged in these efforts.
Where do we go from here?
Our work is far from over. We have gained traction with legislative leaders but, in truth, but are not fully satisfied with this budget, particularly for assisted living Medicaid funding. We clearly have more education to do with policymakers for all our provider types.
In the immediate future, our team is working on a grassroots advocacy plan designed to ensure legislators can tour member care centers, meet the individuals who deliver care and services, and most importantly, meet the patients and residents who rely on long term care support. We will count on your assistance with these initiatives.