During the layoff process, what happens to an employee's PEBB benefits?

To keep eligibility for the employer contribution toward PEBB benefits, an employee must have at least eight hours of pay status in each month. Typically, one full day of work or a full day of paid leave (vacation or sick leave) covers this requirement.

However, if the employee cannot maintain at least eight hours of pay status in a PEBB benefits-eligible position, then their insurance coverage (and insurance coverage for any enrolled dependents) will end on the last day of the month in which they are in pay status for at least eight hours.

If their coverage ends, the employee would be eligible to continue any combination of medical, dental, vision, life insurance, and accidental death and dismemberment (AD&D) insurance under PEBB Continuation Coverage (Unpaid Leave) for up to 29 months, as described in WAC 182-12-133. The employee would be responsible to self-pay the full monthly premium and applicable premium surcharges. The PEBB Program will mail the employee a booklet that describes this option and includes the enrollment form. Learn more about PEBB Continuation Coverage (Unpaid Leave).

If the affected employee has a spouse or state-registered domestic partner who is eligible for benefits with their employer (including PEBB or SEBB), they may enroll as a dependent under their account through a special open enrollment. 

If an employee's health savings account (HSA) contributions are not paid because of a federal government shutdown, will their HSA contribution amounts be deducted from future paychecks? 

No, missed HSA contribution amounts will not be deducted from future paychecks. The employee will not receive their employee contribution if they do not have a paycheck to get the contribution from. Keep in mind, the employee may also revise their election amount by submitting an Employee Authorization for Payroll Deduction to Health Savings Account form to their payroll or benefits office upon returning to work.

What happens to an employee's optional coverage (such as supplemental life, employee-paid long‐term disability, or auto or home insurance) during a federal government shutdown?

Each of these coverages will be handled a little differently:

  • Supplemental life insurance: Coverage will continue as long as the employee is in pay status for at least eight hours before the end of the month. The payroll or benefits office will account for any missed payroll deductions when they return to work.
  • Employee-paid long‐term disability insurance: Coverage will continue as long as the employee is in pay status for at least eight hours before the end of the month. The payroll or benefits office will account for any missed payroll deductions when they return to work.
  • Auto/home insurance: The employee should contact Liberty Mutual at 1‐800‐706‐5525 to ask about alternate payment options to continue their coverage.
What actions may a PEBB benefits‐eligible employee take if they are affected by the federal government shutdown, and their spouse is also an employee who is eligible for PEBB (or SEBB) benefits but is not affected by the federal government shutdown?

The employee who is not affected by the federal government shutdown may enroll their affected spouse under their PEBB (or SEBB) insurance coverage as a dependent if the employee who is affected by the federal government shutdown doesn’t have at least eight hours of pay status. The employee who is adding their spouse as a dependent may do so under a special open enrollment event.

Example: Bill and Jackie are both PEBB benefits‐eligible state employees. Bill works at the Health Care Authority and is being affected by the federal government shutdown. His wife Jackie works at the Department of Transportation (DOT) and is not affected by the federal government shutdown. Jackie may submit her changes and a copy of Bill’s layoff notice (proof of the event) in Benefits 24/7 or to DOT’s payroll or benefits office no later than 60 days after the event to enroll Bill (and any children currently enrolled under Bill’s coverage).

If the federal government shuts down and impacts a PEBB benefits‐eligible employee, what will happen to their PEBB benefits? If they have a medical procedure during the shutdown, will it be covered?

To keep eligibility for the employer contribution toward PEBB benefits, an employee must have at least eight hours of pay status in each month (WAC 182‐12‐131). WAC 182‐12‐109 defines pay status as “all hours for which an employee receives pay.” Typically, one full day of work or a full day of paid leave (vacation or sick leave) covers this requirement. If an employee is not able to work or submit leave for at least eight hours in a month, they will lose eligibility for the employer contribution toward their PEBB benefits; coverage will end on the last day of that month for the employee and any enrolled dependents.

If this happens, the affected employee and their dependents may continue any combination of medical, dental, or vision and may also continue life insurance and accidental death and dismemberment (AD&D) insurance by self-paying the premiums and applicable premium surcharges on a post-tax basis. This is called PEBB Continuation Coverage. Employers make no contribution toward the premiums.

When coverage ends, the PEBB Program will mail a PEBB Continuation Coverage Election Notice booklet to the employee. This booklet describes  available options continuing PEBB insurance coverage.

The PEBB Program offers two types of continuation coverage: PEBB Continuation Coverage (COBRA) and PEBB Continuation Coverage (Unpaid Leave). If an employee loses coverage due to a government shutdown, it would likely be to their advantage to elect PEBB Continuation Coverage (Unpaid Leave) because:

  • This coverage also includes the option to continue life insurance. COBRA offers portability or conversion options for life insurance.
  • This coverage lasts up to 29 months for a layoff. COBRA generally lasts up to 18 months for a termination or a reduction in hours.

Neither option allows the employee to continue either employer-paid long‐term disability insurance or employee-paid LTD insurance due to a layoff or a reduction of hours.

When enrolling in PEBB Continuation Coverage (COBRA or Unpaid Leave), the employee must pay the full monthly premium and any applicable surcharges. The premiums for both options are the same. Premiums can be found in the PEBB Continuation Coverage Election Notice and on the PEBB Program webpage under "Explore costs."

To enroll in PEBB Continuation Coverage (COBRA or Unpaid Leave), the PEBB Program must receive the affected employee's request in Benefits 24/7 or forms and supporting documentation no later than 60 days after their PEBB health plan coverage ends or from the postmark date on the PEBB Continuation Coverage Election Notice, whichever is later.

If the affected employee has a medical procedure during the shutdown, will it be covered?

If the PEBB Program receives the completed enrollment, monthly premium(s), and any applicable surcharge(s) within the timelines stated in the notice, the employee will continue to receive health plan coverage for any covered services they receive during the shutdown. Their PEBB Continuation Coverage (COBRA or Unpaid Leave) will automatically end when they regain eligibility for the employer contribution toward PEBB benefits.

Public employee access and affordability

During the 2025-26 Legislative session, the Washington State Legislature passed Senate Bill (SB) 5083.

The new law (RCW 41.05.028)—also known as the Public Employee Access and Affordability program—sets payment limits (caps) for certain PEBB and SEBB in-network and out-of-network hospitals. It also sets a minimum reimbursement (floor) for primary care and nonfacility behavioral health services. These caps and floors are designed to reduce PEBB and SEBB member and health plan costs and place downward pressure on member premiums, while redistributing reimbursement towards primary care and behavioral health services.

On this page

About

Starting January 1, 2027, this new law (adopted WAC 182-40) aims to increase access and lower costs for PEBB and SEBB members in Washington State by:

  • Limiting how much PEBB and SEBB plans pay for inpatient and outpatient services for most hospitals in Washington State. In general, hospitals will be capped to a limit of 200% of Medicare’s payment for in-network hospitals and 185% for out-of-network hospitals.
  • Setting an alternative payment limit for children’s hospitals in Pierce and King counties using a Medicaid ratio of costs to charges, recognizing the specialized needs of this population.
  • Setting a minimum reimbursement of 101% of Medicare allowable costs for critical access and sole community hospitals.
  • Setting minimum payment levels at 150% of Medicare for primary care and nonfacility behavioral health services.

The law will maintain access and quality of care for Washington State PEBB and SEBB members by:

  • Putting a limit on out-of-network reimbursement for hospitals to incentivize continued in-network participation.
  • Allowing exemptions for certain small and rural hospitals, recognizing their unique demographics and reimbursement structures.

Guides, definitions, and reference materials

Goals

Making health care accessible and more affordable for all Washingtonians is our goal at HCA. As the state's largest health insurance purchaser, HCA plays a key role in developing innovative ways to approach the health care market. Facilitating a new way of how we pay for PEBB and SEBB health care services is a meaningful step forward.

This law will help address:

  • The payment gap for primary care providers and certain behavioral health service providers across the state. The minimum reimbursement threshold may increase access to these services.
  • High and increasing hospital prices. Hospital prices are a significant driver of overall health care cost increases. The established caps will support containment of cost growth in line with annual adjustments that occur to the Medicare program.
  • The variation in hospital pricing, which doesn’t necessarily reflect differences in the cost of delivering care or higher quality.

During the 2025-26 Legislative session, the Washington State Legislature passed Senate Bill (SB) 5083.

The new law (RCW 41.05.028)—also known as the Public Employee Access and Affordability program—sets payment limits (caps) for certain PEBB and SEBB in-network and out-of-network hospitals. It also sets a minimum reimbursement (floor) for primary care and nonfacility behavioral health services. These caps and floors are designed to reduce PEBB and SEBB member and health plan costs and place downward pressure on member premiums, while redistributing reimbursement towards primary care and behavioral health services.

On this page

About

Starting January 1, 2027, this new law (adopted WAC 182-40) aims to increase access and lower costs for PEBB and SEBB members in Washington State by:

  • Limiting how much PEBB and SEBB plans pay for inpatient and outpatient services for most hospitals in Washington State. In general, hospitals will be capped to a limit of 200% of Medicare’s payment for in-network hospitals and 185% for out-of-network hospitals.
  • Setting an alternative payment limit for children’s hospitals in Pierce and King counties using a Medicaid ratio of costs to charges, recognizing the specialized needs of this population.
  • Setting a minimum reimbursement of 101% of Medicare allowable costs for critical access and sole community hospitals.
  • Setting minimum payment levels at 150% of Medicare for primary care and nonfacility behavioral health services.

The law will maintain access and quality of care for Washington State PEBB and SEBB members by:

  • Putting a limit on out-of-network reimbursement for hospitals to incentivize continued in-network participation.
  • Allowing exemptions for certain small and rural hospitals, recognizing their unique demographics and reimbursement structures.

Guides, definitions, and reference materials

Goals

Making health care accessible and more affordable for all Washingtonians is our goal at HCA. As the state's largest health insurance purchaser, HCA plays a key role in developing innovative ways to approach the health care market. Facilitating a new way of how we pay for PEBB and SEBB health care services is a meaningful step forward.

This law will help address:

  • The payment gap for primary care providers and certain behavioral health service providers across the state. The minimum reimbursement threshold may increase access to these services.
  • High and increasing hospital prices. Hospital prices are a significant driver of overall health care cost increases. The established caps will support containment of cost growth in line with annual adjustments that occur to the Medicare program.
  • The variation in hospital pricing, which doesn’t necessarily reflect differences in the cost of delivering care or higher quality.

Changes coming to Apple Health

This page shares information on the recent federal changes to Medicaid (known as H.R. 1) that may impact your Apple Health (Medicaid) coverage. This page is for Apple Health clients. If you are a legislator, partner, or other stakeholders, view our H.R. 1 impacts webpage.

On this page

Federal changes (known as H.R. 1) are coming to Apple Health (Medicaid) over the next few years, but there is nothing you need to do right now. These changes will roll out slowly, and many details are still being developed. We are sharing information now, so you know what to expect.

What this means for you

The Health Care Authority (HCA) is reviewing how these changes will affect Apple Health. Our top priority is to keep you updated and let you know if you need to take action to keep your coverage. We are committed to making any changes as easy as possible.

Changes will roll out over the next few years, and many details are still being developed. If changes to eligibility, coverage, or benefits are required, we will share that information clearly and early, so you know what to expect.

Expected changes

View the following table for examples of some expected federal changes that may affect your coverage.

Change Start date
Changes to eligibility for refugee, asylee, and other noncitizen adults. October 1, 2026
To remain eligible, people enrolled in Apple Health for Adults will be required to work, train, or do community engagement 80 hours per month (with some exceptions). January 1, 2027
People enrolled in Apple Health for Adults will be required to renew their coverage every six months instead of twelve months. January 1, 2027
Retroactive coverage will be shortened from three months to one month for Apple Health for Adults and shortened to two months for all other Apple Health programs. January 1, 2027
People enrolled in Apple Health for Adults will have to pay cost-sharing up to $35 for many services. This does not include primary care, behavioral health, emergency services, and services given in certain rural settings. October 1, 2028

How to stay informed

To make sure you receive important updates:

  • Check this page regularly for new information.
  • Keep your contact information up to date in your Apple Health account so we can reach you.
    • Notices about changes to your coverage will be sent by mail or email, depending on your notification preference.
  • Check your mail and email for important updates about your coverage.

Frequently asked questions

What is H.R. 1?

H.R. 1 also called the “One Big Beautiful Bill Act” (OBBA) is a new law from the federal government. It will bring some changes to public programs in the next few years. Many details are still being worked out.

Do I need to do anything right now?

No. You do not need to do anything at this time. Your current benefits stay the same. View the table under Expected changes to stay up to date on when changes will happen.

Will my benefits change?

Right now, nothing is changing for your benefits. If anything changes in the future, we will tell you early and explain what it means.

When will changes happen?

Changes will happen slowly over several years. They will not happen all at once. We will share new information when we get it. View the table under Expected changes to stay up to date on when changes will happen.

Will I lose my health care or other help?

No. Your benefits do not change right now. If things change later, we will help you understand what to do.

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