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2024 Legislative Session

2024 Legislative Session


This year, the legislative session is 60- days. The so-called “short” session is the second part of the two-year legislative cycle in Washington. In 2023, the legislature passed the state operating budget for July 1, 2023, through June 30, 2025, in a 105-day “long” session. Now, the Legislature will address a plethora of policy measures from January 8 to March 8, 2024.  

Our work as advocates for sustainable, accessible long-term care will continue during the 2024 session. Thanks to those of you who are already engaged in our work.  

2024 Supplemental Budget

WHCA’s priorities for the supplemental budget and Medicaid for the 2024 legislative session are: 

  • Fund the assisted living labor rate so that providers can compete for
  • Ensure that specialized dementia care funding is improved to address costs; and
  • Ensure that skilled nursing facility rates are updated annually to address rate shortfalls that threaten operational viability. 

    Washington Gov. Jay Inslee speaks at a news conference.

Governor Jay Inslee, now serving his final term, has introduced a supplemental budget the focuses on behavioral health, necessitated by a federal lawsuit against Washington. Unfortunately, the Governor’s plan didn’t address an obvious funding disparity in assisted living Medicaid rates. However, the House and Senate will also release proposals before a supplemental plan is adopted. 

Medicaid in Assisted Living 

Assisted living Medicaid rates have lagged for decades. The labor rates for Medicaid providers were discounted to 68 percent of actual cost until July 1, 2023, when they increased to 78 percent. Although this is an improvement and the legislature did allocate additional funding in the 2-year operating budget, reimbursement for wages still falls short.  

Substantial investments were made in other long-term care settings, creating a considerable wage disparity between workers in assisted living facilities and their counterparts in alternative care settings. DSHS estimates that the comparable labor component for adult family home Medicaid rates is funded at 95 percent, compared to 79 percent for assisted living facilities. Additionally, a. A substantial investment was also made to increase wages for Individual Providers (IPs) over the biennium, resulting in an average hourly wage of $22.72 – significantly higher than the $18.55 Medicaid reimburses for assisted living workers. This wage gap is unjust and does not recognize the dedication of staff working in assisted living facilities. 

In their September 2023 budget request to the Governor for assisted living funds, DSHS called out the inequitable treatment in funding:  

“Although a significant improvement, ALF rates are out of alignment with other residential care settings that have seen higher rate increases…the labor component for adult family homes rates is now funded at 95 percent. This separation in funding continues to stress the ALF workforce as they struggle to compete with other care providers.”  

The DSHS decision package request proposed to increase the assisted living labor component from 79 to 95 percent and raise the SDC add-on from $43.48 to $60 per day per client. The estimated fiscal note for this proposal is $56,987,000 ($26,441,000 GF-State). 

What all this adds up to is that without this increased funding, assisted living becomes less accessible to low-income Washingtonians. This funding is critically important. Under current funding levels, there has been a Medicaid caseload decline of 24% since 2017. This trend is unsustainable and jeopardizes the availability of crucial care services for low-income community members who rely on support while in assisted living. Medicaid funding is instrumental in making assisted living more accessible for low-income Washington residents. 

Rep. Ed Abbarno visits Chehalis West AL for a facility tour in December of 2023.

Competitive compensation is vital for attracting and retaining skilled and compassionate workers in the caregiving field. Inadequate funding can lead to understaffing, increased workloads, and caregiver burnout. Sufficient Medicaid funding is a key solution to address these issues, promoting a healthier work environment and reducing burnout rates. 

Please take a moment now to reach out to the legislators who represent you in Olympia to advocate for fair assisted living Medicaid funding: 


PDPM for Skilled Nursing Facilities

The Patient Driven Payment Model (PDPM), created by the Centers for Medicare and Medicaid Services (CMS), changes the way skilled nursing facilities receive reimbursements by classifying patients or residents into groups based on their unique needs.  The Governor’s supplemental budget proposal provides $6.7 million in funding to mitigate rate swings that could occur in an initial transition to the minimum data set using PDPM.  

While the details are unclear, this appears to align with the DSHS proposal to take a first step toward implementing PDPM on July 1, 2024. The DSHS proposal allocates funds for a one-year placeholder that would be followed by stakeholder work to develop a final plan and phase-in schedule for the PDPM. WHCA is engaged in this work and will support DSHS legislation that creates the flexibility needed to implement the program.  

Additional funding is also included to implement the July 1, 2024, skilled nursing facility rebase that was funded in the 2023-25 biennial budget. This adjustment to a 2022 cost base was higher than initially expected. Under the Governor’s proposal, providers would expect to see an increase of $35 per patient day on July 1, 2024, in the average daily weighted rate. We are still very appreciative of the Legislature’s work on skilled nursing facility funding in the two-year operating plan. 

Policy Measures

This issue of discharge appeal rights for residents in community-based settings – including assisted living, adult family homes, and enhanced services facilities – is under consideration in Olympia. Last session, HB 1859 was introduced as an effort to drive legislative attention to the issue. WHCA has met with key legislators to register our opposition to the bill, which would extend all skilled nursing facility resident rights to residential care settings.  

There are pronounced differences in the care setting the types of care offered between skilled nursing facilities and residential care settings in Washington and the current legislation fails to recognize the statutory limitations on the care that can be provided. The Washington LTC Ombuds Program had petitioned DSHS and the governor’s office to engage in rulemaking around this issue. Both declined because of the lack of statutory direction about those rights.  

WHCA has been engaged in stakeholder discussions about the Ombuds proposal, but have significant, remaining concerns about HB 1859. We have been at work with other stakeholders and legal counsel to shape legislative language around the proposal and will keep you apprised of our work in this area. 

Stay In the Loop

We know there will be more bills introduced in Olympia that will affect our members, long-term care residents in Washington, and their families. We are closely tracking and watching those issues, and count on your support to help drive the message about the key role of long-term care in the Washington health care system. 

Look for Capitol Updates on Fridays during session for updates on our legislative work, and please make it a priority to respond to our Calls to Action that will help bring your voice to legislators in Olympia. Check this page often for updates on ways you can use your voice to impact the long-term care community during the 2024 legislative session. 

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