Bill > SB5955

This bill proposes to transform Washington state's Medicaid program from a managed care model to a managed fee-for-service system by eliminating financial risk-bearing intermediaries like managed care organizations by July 1, 2026. The legislation aims to reduce administrative costs, increase transparency, and improve healthcare equity by creating a system where providers are paid directly by the state, and care coordination is funded separately through a new care coordination fund account. The bill establishes definitions for key terms, outlines a transition process, and mandates the creation of local health jurisdictions to provide community oversight. Healthcare providers will be reimbursed at Medicare rates, and a flat care coordination fee will be provided to primary care practices. The Washington Health Care Authority will be responsible for implementing the new system, creating an administrative services organization to handle non-risk administrative functions, and maintaining a publicly accessible data dashboard. The bill also requires annual legislative reporting, ensures public ownership of Medicaid-related data, and stipulates that public health functions remain under direct government administration. The full implementation of these changes is set to be completed by January 1, 2027, with quarterly progress reports to be submitted to the legislature.

Health and Social Services

https://app.leg.wa.gov/billsummary?BillNumber=5955&Year=2025&Initiative=false