HCA priorities

In recent months Congress passed, and the president signed into law, federal legislation that will deeply impact Medicaid (H.R. 1). Currently, the Medicaid program (which Washington calls Apple Health) provides free or low-cost health coverage for nearly 2 million people across our state, including children, adults, pregnant individuals, those 65 years of age or older, and people with disabilities.

Our state has a sixty-year legacy of providing Medicaid to the people in Washington. As the Health Care Authority (HCA) analyzes the impacts of H.R. 1, our top priority is to implement new federal requirements in ways that minimize coverage loss and reduce customer burden.

Implementation timeline

Long description: implementation timeline summary

A timeline that shows which H.R. 1 requirements are due in the next five years, which is also detailed in the following provision table. It also includes other federal requirements:

• December 2025 - Streamlining eligibility rules: Return mail/National Change of Address
• January 2026 - CMS compliance: Medicare Savings Programs and Low Income Subsidy automation
• June 2027 - CMS compliance: non-MAGI alignment
• June 2028 - 1115 waiver: Continuous eligibility ends

Long description: implementation timeline detail in a table format

The following table lists out the federal requirements outlined in H.R. 1 and the dates they go into effect.

Provision	Effective dates
Restrictions on payment for protected health services	July 4, 2025, to July 3, 2026
Rural Health Transformation funding	Washington submitted application in November 2025; awards in December 2025; funding from 2026–2030.
Changes to coverage for lawfully present non-citizens	October 1, 2026
Work requirements for Apple Health for adults (ages 19 – 64)	January 1, 2027, with option to apply for waiver to implement December 31, 2028
Eligibility renewals increase from every 12 months to six months for Apple Health for adults (ages 19-64)	January 1, 2027
Address verification	January 1, 2027
Retroactive coverage reduced	January 1, 2027
Reduced home equity limit and removed hardship waivers for long-term care (LTC) eligibility	January 1, 2028
Provider Tax restrictions	No new provider taxes, effectively immediately. Phased in provider tax caps starting January 1, 2028.
State Directed Payment (SDP) restrictions on payments to hospitals, academic medical centers and nursing facilities	New SDPs cannot exceed Medicare levels. Grandfathered SDPs, 10% reductions begin in 2028; Continue to reduce by 10% each year until they reach Medicare levels.
Medicaid cost-sharing requirements	October 1, 2028
Good-faith waiver audit findings removed	October 1, 2029

Resources

We will post more resources to this page as HCA and our partners develop them.

About Medicaid (Apple Health) in Washington

Medicaid spending data and potential impacts of federal budget reduction proposals. These resources are updated regularly.

• Slide deck
• Fact sheet

Learn about Apple Health enrollment specialists and how clients can get help applying for health care coverage through Washington Healthplanfinder^TM.

• Enrollment specialists fact sheet

Stakeholder webinars

H.R. 1 Impacts

Join us for the first H.R. 1 Impact stakeholder webinar.

Date: February 26

Time: 12:30 - 1:30 p.m.

Register for the webinar

Presentations to the Washington State Legislature

Date	Topic	Legislative committee	Recording
December 4, 2025	Federal funding update (H.R. 1) - joint presentation with the Office of Financial Management (OFM) and the Department of Social and Health Services (DSHS)	House Appropriations Committee	Watch a recording of HCA's portion (December 4)
November 5, 2025	H.R. 1 Federal Rules briefing	Joint Select Committee on Health Care and Behavioral Health Oversight	Watch a recording (November 5)
October 16, 2025	H.R. 1 Impacts to Medicaid	Senate Ways & Means Committee	Watch a recording (October 16)
July 22, 2025	Federal Impacts to Medicaid	Senate Health & Long-Term Care Committee	Watch a recording (July 22)

Announcements

About the SDM Skills Course

The online SDM Skills Course is based on published research and practical wisdom from dozens of providers who have successfully implemented SDM with thousands of patients in their real-world clinical practice and research studies.

The course focuses on core competencies that build provider confidence in doing SDM effectively.

The exercises assess common barriers and engage the learner through interactivity, instant feedback from a virtual coach, and video examples.

Course details

Today’s health systems realize that providers need training to improve the SDM conversation. Prioritizing and implementing changes that matter most to patients and work best for providers doesn't have to be difficult with the right strategies and tools. The SDM Skills Course developed by Healthwise^© is an online interactive program that uses the following six strategies to help providers deliver a consistent approach to shared decision making:

1. Invite the patient to participate.
2. Present options.
3. Provide information on the benefits and risks.
4. Assist patient in evaluating options based on their goals and concerns.
5. Facilitate deliberation and decision making.
6. Assist with implementation.

Get help setting up an account to access the training.

CME credit information

You can earn 1.5 enduring materials, self-study American Academy of Family Physicians (AAFP) prescribed credits.

American Medical Association (AMA) and AAFP equivalency

Providers may choose to include the following in addition to the AAFP credit statement: AAFP prescribed credit is accepted by the AMA as equivalent to AMA Physician's Recognition Award (PRA) Category 1 credit(s)™ toward the AMA PRA. When applying for the AMA PRA, prescribed credit earned must be reported as prescribed, not as category 1.

Visit the AAFP credit system website for all AAFP credit equivalencies and recognition.

About the waiver

We believe American Indian/Alaska Native (AI/AN) people should have access to traditional health care — also known as Traditional Indian Medicine — to support their health and well-being. Together with Tribes, we can strengthen traditional health care as an Apple Health (Medicaid) benefit and strengthen Native communities.

From November 5–December 20, 2025, HCA held a formal public period for people to share their input on reimbursing traditional health care services. This information is helping us finalize Washington state’s waiver application, which we plan to submit to the Centers for Medicare & Medicaid Services (CMS) in early 2026.

Read the executive summary for more details.

Our goals

Washington state is seeking CMS approval to implement a waiver to:

• Affirm Tribal Sovereignty by recognizing traditional health care practices as an essential component of the AI/AN health system in Washington state.
• Expand people’s access to traditional health care practices provided by or through qualified facilities in Washington state.
• Integrate traditional health care practices into the broader continuum of care, complementing Western medical practices with options that reflect AI/AN cultures, values, and connectedness.
• Improve health outcomes for AI/AN people and increase the use of traditional health care practices in Native communities.

If approved, the waiver could begin as soon as July 1, 2026.

Background

American Indian and Alaska Native (AI/AN) people have long recognized that traditional health care practices are essential to healing and wellness. The 29 federally recognized Tribes in Washington state have rooted these practices—often called Traditional Indian Medicine—in their cultures.

For years, Tribes have championed the recognition of these valued practices and worked toward sustainable funding to expand and ensure timely access to this vital care.

How the waiver will work

If CMS approves the waiver, it will allow certain types of facilities in Washington state to provide traditional health care services as "qualifying facilities," including:

• Indian Health Service (IHS) facilities
• Tribal facilities
• Urban Indian Health Organizations (UIHOs), depending on state funding from the Legislature

When a qualifying facility provides traditional health care services to an eligible Apple Health or Children’s Health Insurance Program (CHIP) enrollee, Medicaid will reimburse (pay) that facility for the service. Such services must be provided by practitioners or providers who are employed by or contracted with a qualifying facility.

Qualifying facilities that receive Medicaid reimbursement (payment) for providing traditional health care is a significant step in:

• Improving access to culturally relevant, holistic care
• Addressing health disparities
• Promoting health equity
• Helping preserve cultural practices

It also empowers Tribes to provide whole-person care, which better serves their communities through a stronger, more effective health care system for AI/AN people.

Whole-person care considers a person’s entire well-being, including physical health, mental and emotional health, substance use, spiritual and cultural needs, and social factors.

Examples of traditional health care practices

This could include drumming, talking circles, sweats, spiritual counseling, rites of passage ceremonies, cultural guidance for traditional plant and food gathering, preparation and preservation, and more.

Why this waiver is so important

The waiver is one way we can ensure Tribes are recognized — and paid — for providing traditional health care services. This waiver also builds off the 2023 Washington State Indian Health Improvement Advisory Plan. We remain committed to strengthening Tribal-state partnerships, improving access to essential care for AI/AN people, and supporting Indian health care development.

Tribal Roundtables

In March, we are offering a Tribal Roundtable discussion for Tribes to share their input.

You must be officially chosen by your Tribal Council as an elected official or appointed representative to participate in government-to-government discussions with the state.

Tribal Roundtable details

Meeting type	Date and time	Zoom and call-in information
Tribal Roundtable discussion Attendees can join in person, attend virtually, or call in.	Wednesday, March 4, 2026 10 a.m.–noon   Health Care Authority Cherry Street Plaza Eagle Conference Room 626 8th Avenue SE Olympia, WA 98501 View the visitor map and parking information.	Meet on Zoom Meeting ID: 858 8393 7707 Call in: 1-253-215-8782 (Tacoma) 1-253-205-0468 (U.S.) See more information on how to join.

Resources

Draft application and other materials

• Traditional Health Care Practices waiver draft application
• Executive summary
• Dear Tribal Leader Letters (DTLLs):
  • Notice of Roundtable (January 27)
  • Tribal Consultation rescheduled (December 16)
  • Tribal public comment notice extension (December 1)
  • Tribal public comment notice (October 30)
  • Initial letter about HCA’s intent to apply for a Traditional Health Care Practices waiver (August 19)
• Public comment notice
• Public hearing slide deck

News

• Get updates on our waiver work!
• Announcements:
  • Reminder about tomorrow's Tribal Consultation for Traditional Health Care Practices waiver (December 15)
  • Don't miss this week's public hearing on WA’s Traditional Health Care Practices waiver (December 8)
  • Public comment period extended for WA’s Traditional Health Care Practices waiver (December 1)
  • Change in location for Wednesday's Traditional Health Care Practices waiver public hearing (November 17)
  • Want to learn more about WA's Traditional Health Care Practices waiver? Attend one of our public hearings! (November 12)
  • Public comment now open (November 5)

Waiver-related

• Visit the CMS website to view all state Section 1115 waivers. Once HCA submits Washington's Traditional Health Care Practices waiver, it will be available on this page, made searchable by state, newest waivers, and other filters.