Northwest Health Law Advocates Health Care Access in the Washington Legislature. Final Biennial Budget : Selected Provisions of Interest

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1 Northwest Health Law Advocates Health Care Access in the Washington Legislature Final Biennial Budget : Selected Provisions of Interest Note: This chart does not include funding for enacted bills that are included in the NoHLA 2015 Legislative Summary. See the Summary for information on those items. Item HEALTH CARE AUTHORITY Community Health Centers/I-502 ACA CHIP Match Customer Service Staff Eligibility Staff Bleeding Disorders CHP Immunizations Initiative 502, passed by voters in 2012, authorizes the regulation, sale, and taxation of marijuana for adults over the age of 21. The initiative directed a portion of the tax revenue to fund primary, dental, migrant, and maternity health care services through contracts with community health centers. The Health Care Authority will use the tax revenue in lieu of state general fund payments to community health centers for services provided to medical assistance clients. The federal Affordable Care Act (ACA) provides a 23 percent increase to the federal match rate for the Children's Health Insurance Program starting October 1, 2016, and lasting through September 30, This will increase Washington's match rate from 65 percent to 88 percent. Funding is provided to address increasing call volumes due to the Medicaid expansion and restoration of adult dental benefits. This increase will cover costs related to the higher volume of incoming calls to the toll-free line and necessary translation fees. Implementation of the ACA resulted in the enrollment of new Medicaid and Children's Health Insurance Program (CHIP) clients. The accelerated enrollment rate has increased eligibility staff workloads. Funding is provided to support timely resolution of eligibility-related client issues. Funding is provided to establish a Bleeding Disorder Collaborative for Care to identify and develop evidence based practices to improve care for patients with bleeding disorders. Funding is provided to work with the Department of Health to acquire vaccines for approximately 18,500 children enrolled in state-funded Apple Health (Children's Health Program). -17, , ,000 3, , ,343 2,343 HBE Call Center Funding is provided for the Exchange's customer support call center. 0 9,824 HBE In-Person Assisters Funding is provided for in-person assisters that provide information to help individuals and families complete their Washington Healthplanfinder applications and enroll in health insurance coverage. 1,387 6,382 1

2 HBE Shared Costs HBE Information Technology HBE Operations Healthier Washington Health Homes Low Income Health Care Premium Aggregation Medication Assisted Therapies The Health Benefit Exchange operates and maintains the Healthplanfinder (HPF) website and supporting systems that determine eligibility and enrollment for applicants of subsidized health care coverage. With implementation of the Modified Adjusted Gross Income rules for Medicaid eligibility determinations, eligibility for a majority of medical assistance clients is now processed through the HPF website and other related systems. Funding is provided for anticipated Medicaid-related costs for operations and system maintenance. Funding is provided for ongoing design, development, implementation, operation, and maintenance of the information technology systems that support the Washington Healthplanfinder. Funding, in addition to that for IT, call center, and in-person assistance, is provided to support the Exchange's operations including consulting and auditing work, marketing, and printing. The Health Care Authority received more grant funding than anticipated to implement the State Health Care Innovation Plan, now called the Healthier Washington program. Health Homes is an existing pilot program that integrates care within existing systems for highrisk, high-cost adults and children, including those who are dually-eligible for Medicare and Medicaid. Funding for dual eligibles ends September 31, Funding is provided to continue providing Health Homes services for dual eligibles only until December 31, Initiative 502 directed a portion of the revenue from taxes on the sale of marijuana into the Basic Health Trust Account. Those dollars are used in lieu of General Fund-State dollars for capitation payments for Medicaid clients enrolled in managed care plans. The Health Benefit Exchange will stop collecting premium payments from customers on behalf of qualified health plans (QHP), and the QHPs will be responsible for that function. Funding is provided for expanded treatment for Medicaid clients with opioid and alcohol use disorders using buprenorphine and other approved medications. 0 9, , , ,120-3,883 2, , , ,163 DEPARTMENT OF SOCIAL & HEALTH SERVICES Children and Family Services Extended Foster Care (EFC) - Medical SSB 5740 expands Extended Foster Care eligibility to youth who are unable to engage in any EFC-qualifying activity due to a documented medical condition. This budget item funds medical care for newly-eligible youth ,192 2

3 Juvenile Rehabilitation Administration Mental Health Services for Incarcerated Youth Mental Health Transitional support, including behavioral health telemedicine, to ensure that there is no gap in mental health services when a youth arrives at a JRA facility from a community detention facility Single-Bed Certification Funding for RSNs Office of Forensic Mental Health Civil Commitment Ward at WSH Program for Adaptive Living Skills - Alternate Services Medicaid Rates Psychiatric Intensive Care Unit (PICU) Psychiatric Emergency Response Team (PERT) Funding is provided to reimburse RSNs for delivery of services under the Involuntary Treatment Act (ITA) to individuals placed in "single bed certifications," when no placements are available in Evaluation and Treatment Facilities. 31,400 49,662 Funding is provided under ESSB 5177 to staff the Office of Forensic Mental Health 4,178 4,178 Continued funding is provided for a 30 bed civil admission ward at Western State Hospital that was originally funded as part of the early action supplemental operating budget(shb 1105). Previously, when the Program for Adaptive Living Skills was closed, non-medicaid state funding was allocated to substitute in part for the loss of PALS services. That funding is now eliminated. RSN rates for disabled adults, non-disabled adults, disabled children, and non-disabled children are reduced. Funding provided for PICUs at WSH and ESH to house "high acuity"/assualtive patients for short time periods before transitioning them back to other hospital wards. Provides funding for expanded PERTs and expansion of the hours during which these services will be available. 7,578 7,578-10,400-10,400-16,462-32,930 3,782 3,782 3,497 3,497 Developmental Disabilities Service RHC Medicaid Compliance Specialized Services for Clients with Developmental Disabilities Funding for additional staff at Residential Habilitation Centers is provided to ensure compliance with various legal requirements. Funding for specialized services to be provided to individuals with developmental disabilties as indicated by Pre-Admission Screening and Resident Review assessments, and required by CMS. 5,956 11,912 1,116 2,190 3

4 Basic Plus HCBS Waiver Transition ACA CHIP Match Yakima ValleySchool Crisis Stabilization Program Enhanced Respite for Families of Children with Developmental Disabilties Community Respite Beds Clients with developmental disabilities who are currently receiving state-funded supported employment and day support services and who are eligible for the Basic Plus HCBS waiver are being placed on the waiver program so that their services can be paid for in part by the federal Medicaid match. Individuals receiving the state-funded services who are not eligible for the waiver may continue to receive them. ACA provies 23% increase to the federal match rate for the SCHIP program (Apple Health for Kids with Premiums), increasing Washington's match rate from 65% to 88% -2,800-2, Funding is provided for emergent respite services at the Yakima Valley School Funding for short-term community-based respite services for parents of children with DD to allow for stablization of children in behavioral crises and subsequent return to their home placement. Funding provided for short-term community respite servies across the state for persons with DD, as an alternative to institution-based respite. 1,300 2,100 1,100 1,800 Long-Term Care Area Agencies on Aging (AAA) - Caseload reduction Nursing Home Investigations Specialized Communications Equipment for Persons with Disabilities Health Homes Long-Term Supports Insurance Study Funding provided to lower staff to client ratios for AAA staff providing case management to clients receiving MPC. Funding provided for additional staff to conduct licensing, inspections, and complaint investigations of nursing homes. Funding provided for equipment for low-income persons with hearing and/or sight impairment, to help them effectively access telecommunications services, the internet and other communications modalities and equipment. Funding provided to continue providing health home services for eligible fee-for-services Apple Health clients, primarily individuals who are eligible for both Medicare and Medicaid, through December 31, 2015, effectively terminating the program. Funding provided for actuarial study of options to finance long-term care insurance for Washington residents through public and private financing. 5,228 10,454 1,000 2,

5 Alcohol & Substance Abuse FAS Evaluation Training Substance Abuse Prevention Grants Substance Abuse Prevention and Treatment Programs Funding Shift to I-502 Funds Home Visiting Services Parent-Child Assistance Program Life Skills Training Tribal Prevention and Treatment Services Youth Residential Treatment Evidence-Based and Promising Practices for Youth Services Medicaid Funding for Apple Health Enrollees Under DOC Community Supervision Federal expenditure authority is authorized for expanding FAS Diagnoist and Prevention Network services that can be billed to Medicaid Funding is provided for community-based services, including school resource officers, to prevent and reduce substance abuse. A variety of programs have their funding shifted from General funds - state and substance abuse block grants to the Dedicated Marijuana Revenue Account to achieve savings. Home visiting services will be increased with this new funding transferrred to the Home Visiting Services Account. Funding is provided to aid pregnant and parenting women through the Parent-Child Assistance Program. Grant-funding for the OSPI is authorized for life-skillls training for youth in high-needs communities ,000-16,496 4, , Increased funding to tribes for services to prevent and treat substance abuse by children Increased funding for youth residential treatment services 0 5,267 Funding for evidence/research-based and promising practices to prevent and reduce youth substance use disorders Funding for community-based outpatient substance use services to Medicaid enrollees under DOC community supervision to be purchased by Behavioral Health Organizations (BHOs) beginning on April 1, ,538 5

6 Economic Services Administration Providing One-Stop Access and Medicaid application help to people applying for assistance ("Medicaid Cost Allocation") Medicaid Waiver Application Also known as the "Single Point of Entry" proviso, DSHS Community Services Division (CSD) staff are required to help people apply for Medicaid through WA Healthplanfinder by October 1, The budget also reduces CSD staffing by 41.5 FTEs based on assumed administrative efficiencies. DSHS and HCA are required to apply for a federal waiver to the federal government to use SNAP eligibility to enroll eligible persons in Medicaid. DSHS and HCA are required to apply for a federal waiver to the federal government to use SNAP eligibility to enroll eligible persons in Medicaid (Budget proviso only). 0-8, DEPARTMENT OF HEALTH Tobacco and Marijuana Prevention Healthiest Next Generation Initiative Diabetes Epidemic Marijuana education and public health program, and tobacco prevention activities that target youth and populations with a high incidence of tobacco use. 0 14,500 Funding for one FTE Coordinator of the initiative Collaborate with DSHS and HCA to identify goals, benchmarks, and plans for preventing and controlling diabetes OFFICE OF INSURANCE COMMISSIONER Access to Health Care Providers Funding is provided for two positions to address the additional workload for the regulatory review of health care provider networks Northwest Health Law Advocates nohla@nohla.org July 23,