Bill > SB5258

This bill addresses improper Medicaid concurrent enrollment payments by implementing several measures to reduce unauthorized overlapping healthcare coverage across state lines. The bill requires the Washington State Health Care Authority and Department of Social and Health Services to collaborate on identifying and addressing instances where individuals are enrolled in multiple Medicaid programs, including by working with federal agencies like the Social Security Administration and Centers for Medicare and Medicaid Services to clarify out-of-state residency eligibility. Starting in January 2026, managed care organizations will be required to conduct monthly analyses of their enrollment records to identify individuals enrolled in multiple state Medicaid programs, recover premiums for enrollees who have moved out of state, and report their findings to the state authority. The bill also mandates that the state agencies annually analyze client addresses using the national change of address database to identify individuals who have relocated. Additionally, the bill requires the state auditor to conduct a performance audit by December 31, 2031, to examine concurrent Medicaid enrollments, evaluate the state's progress in limiting unnecessary premiums, and provide recommendations for future improvements. As a supplementary provision, the bill also adds requirements for the health care authority to ensure that program eligibility notices meet plain language guidelines and include "address service requested" on all mailings.

Budget and Finance, Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5258&Year=2025&Initiative=false