Apple Health (Medicaid) rulemaking

The agency is amending this rule to include state-funded long-term care services provided in an intermediate care facility for individuals with intellectual disabilities authorized by the Washington State Department of Social and Health Services, Developmental Disabilities Administration.

The agency is amending this rule to update a statutory citation.

The agency is developing rules under ESSB 5187 Sec. 211 (83), 68th Legislature, 2023 Regular Session. This legislation directs the agency to implement a program with coverage comparable the categorically needy Medicaid program for certain adults age 19 and older who: (a) have an immigration status making them ineligible for Medicaid or federal subsidies through the Health Benefit Exchange; and (b) are not eligible for another full scope federally funded medical assistance program.

The agency is revising this rule to remove age specific language in subsection (3)(c) and remove subsection (3)(d) to make it less prescriptive and align with HCA’s Health Technology Clinical Committee (HTCC) decision findings. Additionally, the agency is updating the developmental disabilities administration name to align with the name change initiated by the department of social and health services.

The agency is amending these rules to add dental therapists as an eligible provider type.

The agency is amending these rules to comply with RCW 74.09.837 and 2E2SSB 5580, Sec. 2 updating the maternity support services program to address perinatal outcomes and increase equity and healthier birth outcomes. Additionally, the agency is amending language to align with gender neutrality, updating screening requirements, adding care coordination with birth doulas, allowing telehealth, and adding an additional payment for a risk factor screening and a postpartum nurse home visit.

The agency is amending its rules to increase the income standards for pregnancy and postpartum groups from 193% to 210% of the federal poverty level. This
increase is consistent with legislative directives in chapter 213, Laws of 2024 (2E2SSB 5580).

The State Supplemental Operating budget (section 211 (34), Chapter 376, Laws of 2024, (ESSB 5950)), included funding for the Health Care Authority (HCA) to implement a birth doula benefit for Apple Health (Medicaid) clients. HCA is developing rules in Chapter 182-533 WAC and amending WAC 182-502-0002 to accomplish this.

The agency is amending this rule to expand screening and preventative services for certain sexually transmitted infections during a client visit focused on family planning.

RCW 74.09.830 provides full-scope coverage for 12 months postpartum for pregnant or postpartum persons. This coverage is more generous than and thus replaces the limited scope “Family planning only – Pregnancy related program.” The agency intends to remove language related to this superseded program from chapter 182-532 WAC.