Legislative priorities

About HCA’s legislative priorities

HCA faces unique challenges driven by both federal and state pressures. Federal changes—like the passage of H.R. 1 in July 2025, along with required and shifting federal directives—impact every pillar of HCA’s work. These changes will generate significant work in the years to come, requiring staffing and technology resources to ensure that:

• As many Washingtonians as possible can keep their health care coverage.
• We are in compliance with federal regulations to avoid any fiscal consequences.

At the same time, many in Washington still struggle to access to quality and affordable health care, which is further compounded by the state’s current fiscal realities. Increasing state costs, federal funding cuts, population growth, and ongoing economic uncertainty all contribute to anticipated budget shortfalls during the 2027–2029 biennium.

HCA’s 2027 agency request legislation and decision packages seek to meet these challenges through building on the significant investments our state has made in the health care delivery system over the past decade. HCA seeks to keep the state well-positioned to drive better health outcomes and control costs.

Agency request legislation 

Third-party liability enforcement

Provides HCA with rulemaking authority to enforce existing requirements of health insurers to provide third-party eligibility information to the agency, in alignment with federal Medicaid coordination of benefit requirements. 

• View the third-part liability enforcement fact sheet
• View the third-part liability enforcement Z draft

Substance use disorder (SUD) patient rights

Allows HCA to enforce prohibitions on discrimination by providers and treatment facilities against patients who are on or in need of medications for treating substance use disorder, driven by annual complaints about facilities inappropriately restricting access to medications for opioid use disorder (MOUD).

• View the SUD patient rights fact sheet
• View the SUD patient rights Z draft

Healthy Youth Survey

Amends the Public Records Act (RCW 42.56.320) to exempt student survey responses to the Healthy Youth Survey from public disclosure to protect against the potential re-identification of survey respondents.

• View the Health Youth Survey fact sheet
• View the Health Youth Survey Z draft

Public option

Strengthens Washington’s public option program (Cascade Select), including adjusting the reference pricing structure, broadening hospital participation requirements, and connecting Cascade Care Savings (state subsidies) to public option enrollment, with the goal of increasing provider access and the affordability of plan offerings for Health Benefit Exchange customers.

• View the public option fact sheet
• View the public option Z draft

Decision packages

Federal response

H.R. 1 caseload impacts – Seeking $20 million ($9.968 million) annually, ongoing, for additional enrollment of clients who need long-term services and supports into the state-funded Medical Care Services program in response to H.R. 1 immigration changes.

H.R. 1 Work Requirement maintenance and operations support – Seeking $32 million ($10.678 million GF-S) for FY 2028–2029 to meet H.R. 1 compliance requirements while mitigating negative client impacts. This includes supporting increasing demands on enterprise staff, investing in Clinical Data Repository (CDR) technology, and sustaining the Master Person Index (MPI). 

Federal interoperability and prior authorization – Seeking $10.9 million ($4.037 million GF-S) for FY 2028–2029 to comply with new Centers for Medicare & Medicaid Services (CMS) rules, support electronic prior authorization, and increase drug prior authorization reporting. 

Ex Parte/CMS Rules – Seeking funding to continue the project to transition Classic Medicaid enrollment to Healthplanfinder in alignment with federal requirements. Fiscal modelling is still being completed for this package.

Federal pharmacy data mandate – Seeking $4.4 million ($528,000 GF-S) in FY 2028–2029 to support the POS vendor, making necessary system changes to implement a new file format.

H.R. 1 Rural Health Transformation Program – Seeking federal spending authority to continue statewide investments as part of Washington’s Rural Health Transformation Project.

Apple Health access

Apple Health Expansion fee-for-service (FFS) transition – Seeking $3.772 million GF-S in FY 2028–2029 to support administrative costs and language access services associated with moving the AHE program from managed care to FFS. 

Health Home continuation – Seeking $56 million ($20.322 million GF-S) in FY 2028–2029 to continue the program through the biennium for the eligible high-risk population and support modelling of ongoing costs to support this population. 

Postpartum coverage – 1115 waiver population – Seeking $1.1 million GF-S, annually beginning in FY29, to transition individuals enrolled in the After Pregnancy Coverage program under 1115 waiver authority to state funded FFS because federal authority expires. 

School-based services cost reimbursement – Seeking to sunset the current reimbursement options and transition schools to cost-based reimbursement models. The policy is projected to reduce annual state expenditures.

Oral health access for clients with disabilities – Seeking $2 million ($1.03 million GF-S) in FY 2028–2029 to increase prevention, early intervention, and tele-dentistry services through sustainable reimbursement and partner with the Department of Social and Health Services to implement oral health screenings. 

WA Cares Fund maintenance and operations – Seeking $3 million in non-GF-S spending authority for FY 2028–2029 to support adequate staffing and other maintenance and operations costs associated managing the Washington Cares Fund (WA Cares) Program. This program is funded through the Long-Term Services and Supports Trust Account.

IT investments

Health Care Management and Coordination System (HCMACS) Electronic Health Record – Seeking $109 million ($33.674 million GF-S) in FY 2028–2029 to continue Washington’s investment in statewide electronic health record (EHR) infrastructure. Costs to stand-up and operate the statewide EHR span multiple agencies, including HCA, Department of Social and Health Services, and Department of Corrections. 

Tribal health

Traditional Health Care Practices – Seeking $85 million ($338,000 GF-S) in FY 2028–2029 to cover Traditional Health Care Practices in the Medicaid program through a section 1115 demonstration waiver. The majority of funding will come from federal financial support and local-share expenditures.

Tribal evaluation and treatment center – Seeking ongoing funding to support cost-based rates for Tribal evaluation and treatment facilities providing mental health services. Fiscal modelling is still being completed for this package.

Behavioral health

ASAM 4th Edition implementation and support – Seeking $20.9 million ($9.492 million GF-S) in FY 2028–2029 for resources necessary to transition the treatment and care of clients with substance use disorders to the 4th edition ASAM criteria by January 1, 2028, in alignment with RCW 71.24.619. Funding will support training, technical assistance, and Medicaid rate changes. 

Crisis stabilization facility operations – Seeking $29.274 million GF-S in FY 2028–2029 to support the costs of uninsured and underinsured individuals receiving services in newly opened Crisis Relief Centers or Crisis Stabilization Units. 

Certified Community Behavioral Health Clinic (CCBHC) maintenance – Seeking $9.8 million ($9 million GF-S) in FY 2028–2029 to, support agency administration of the CCBHC program, and funding for existing providers through a continuation of bridge grants.

Trueblood Phase 2 – Crisis Stabilization – Seeking funding to support Trueblood implementation, including contracting with a King County crisis stabilization bed provider to assist with start-up and operating funds. Fiscal modelling is still being completed for this package.

Trueblood Phase 3 – Crisis Stabilization – Seeking funding for start-up and operational costs associated with a crisis stabilization facility located in the Thurston/Mason region. The Trueblood Contempt Settlement Agreement requires the state to ensure that there are crisis stabilization beds in each of the phased regions. Fiscal modelling is still being completed for this package.

Trueblood Phase 5 – Seeking funding to support phase 5 of the Trueblood settlement agreement currently being negotiated. Fiscal modelling is still being completed for this package.

Rates, benefits, and operations

Primary Care Case Management – Seeking $120,000 GF-S in FY 2028 to plan for the creation of a new Primary Care Case Management Entity (PCCMe) program operated by Tribes and Indian Health Care Providers. The PCCMe would provide case management and care coordination services to fee for service enrolled American Indian and Alaskan Native clients.

Department of Health newborn screening fee increase – Seeking $1.7 million ($309,000 GF-S) in FY 2028–2029 to increase Medicaid funding to cover newborn screening fee increases proposed by DOH. 

Budget reduction options

HCA proposed reduction options – In light of current state budget conditions, HCA, at the direction of the Governor’s Office and Office of Financial Management (OFM), is putting forward various options that could reduce agency expenditures. Proposed reductions include:

• Changes to Medicaid benefit design
• Changes to Public and School Employee benefit designs
• Changes to Medicaid program eligibility criteria
• Changes to provider rates
• Elimination or reduction of certain contracts, studies or workgroups, including through administrative efficiencies

HCA acknowledges the real impact that funding reductions can have on our clients, providers, communities, and important services. These options reflect an attempt to do the least harm, while still putting forward options that meaningfully reduce agency and programmatic spending.

Additional detail on proposed reductions can be found within formal Decision Packages on OFM’s Agency Budget Requests page.