Bill > SB5372

This bill creates the Medicaid Access Program, a new initiative designed to increase Medicaid professional service rates to match Medicare rates. Health carriers (insurance companies) and Medicaid managed care organizations will be required to pay an annual assessment based on their covered lives, with Medicaid managed care organizations paying $18 per member per month and health carriers paying $0.50 per member per month. The collected funds will be deposited into a new Medicaid Access Program account and used to incrementally raise Medicaid professional service rates across various categories including anesthesia, emergency room services, surgical procedures, office visits, and other physician services. The program aims to begin rate increases on January 1st of the second plan year after receiving federal approval, with rates potentially adjusted to a percentage of Medicare rates if sufficient funds are not available. The bill requires the Washington State Health Care Authority to submit necessary state plan amendments or waiver requests to the Centers for Medicare and Medicaid Services by September 1, 2025, and includes provisions for annual rate adjustments using the Medicare Economic Index. The program will expire if federal approval is not received by January 1, 2027, and includes liability protections for the program, health carriers, and managing agencies when actions are taken in good faith.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5372&Year=2025&Initiative=false