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One year extension and amendment

The Medicaid Transformation Project (MTP) is a five-year Section 1115 Medicaid demonstration waiver between the Health Care Authority (HCA) and Centers for Medicare & Medicaid Services (CMS). HCA is seeking CMS approval to amend our existing waiver to:

  • Allow Medicaid reimbursement for dental health aide therapist (DHAT) services at Indian health programs within the state.
  • Provide flexibility related to long-term services and supports (LTSS).
  • Align the value-based payment (VBP) target for year 5 of MTP because of state adjustments due to COVID-19.

HCA is also seeking CMS approval to extend for one year to create a sixth year for MTP.

About the extension

The COVID-19 pandemic has strained our health care system, essential workers, families, and communities. It has uncovered structural inequities in the health care system, and dramatically affected vulnerable populations and the providers who serve them. MTP is well-positioned to mitigate the challenges of COVID-19.

An extension would allow Washington State to continue its COVID-19 relief efforts through each of the MTP initiatives. It would also serve to further the continued implementation of the MTP’s transformational goals.

Learn more about HCA’s request for an extension.

About the amendment

We are requesting an amendment to:

  • Authorize Medicaid reimbursement for dental services provided by DHATs. DHATs are an innovative mid-level dental provider type who help extend the services available under the supervision of a dentist. DHATs have been providing services in Alaska and in other countries for decades. This change will support tribal efforts to expand access to dental services on tribal reservations.
  • Extend the LTSS presumptive eligibility process so patients can access essential services immediately, rather than having to undergo a financial eligibility determination and a full functional eligibility assessment first. This change would also include access to appropriate LTSS programs through Community First Choice and 1915(c) waivers.
  • Change the definition to allow transportation to community supports and services. Through this amendment, Washington State will offer transportation—according to a participant’s service plan—to MTP-based services, community supports, as well as other activities specified in the service plan.
  • Adjust the 2021 managed care organization VBP adoption target from 90 percent to 85 percent. This adjustment has already been made within Apple Health contracts. This change will ensure the MTP target aligns with the Apple Health Appendix and state VBP target because of COVID-19.  In addition, the state is seeking an adjustment to the way improvement is calculated for VBP-related incentives under MTP.

Webinars about the DHAT amendment

HCA will host two public notice webinars via Zoom to provide an overview of the amendment. Attendees will have an opportunity to ask questions and share feedback. Registration is not required.

Live captioning available: to request this accommodation, please submit a request to as soon as possible. We will make every effort to request a Communication Access Real-time Transcription (CART) writer but cannot guarantee that one will be available.

How to share public comment

Feedback is an important part of our DHAT amendment process. You can share your public comment or testimony:

  1. During one of the DHAT public notice webinars.
  2. By contacting us at
  3. By mailing us at:
    Washington State Health Care Authority, Policy Division
    Regarding: DHAT amendment public comment
    Attention: Tamarra Henshaw
    Mail Stop 45502
    628 8th Avenue SE
    Olympia, WA 98501

The deadline to provide public comment is October 15, 2021.


    DHAT amendment

    One-year extension and amendment

    Public notice webinar recordings

    DHAT amendment

    One-year extension and amendment