The multi-faceted health care delivery system in Washington includes a variety of private and public providers, and individual, private and public payers. Individual choices are numerous and work is being done at all levels to achieve the Triple Aim of better health, better care, and lower cost.

Sources of health insurance for people in Washington include the following:

Medicaid in Washington

In Washington, Medicaid is included in the group of medical assistance programs named Washington Apple Health, and the Health Care Authority (HCA) is responsible for its administration. HCA purchases health care for more than 2.5 million people, nearly a third of Washington residents, through Apple Health (Medicaid), the Public Employees Benefits Board program, the School Employees Benefits Board program and the Compact of Free Association (COFA) Islander Health Care program. A total of 1,898,841 people in Washington, including more than 800,000 children under age 19, have Apple Health (HCA, July 2020).

HCA contracts with managed care organizations to provide physical and behavioral health care services. As of July 2020, over 84 percent of Apple Health clients were enrolled in managed care, the rest in fee-for-service.

The state Title V program works in partnership with HCA to help ensure alignment of resources, services and programs, and that women and children are provided their covered benefits such as preventive services, health examinations, treatments and follow-up care. We have data sharing agreements with HCA that help us determine the reach and effectiveness of programs and assist us in determining whether people receive their appropriate services. Our agreement with HCA is included in this application.

Medicaid Section 1115 Waiver – Medicaid Transformation

The state is pursuing strategic changes within Medicaid to allow us to move toward better health. In January 2017 Washington entered an agreement with the federal government, a Section 1115 waiver, which allows us to test new, innovative approaches to providing health coverage and care, and to manage costs.

This five-year contract with the Centers for Medicare & Medicaid Services (CMS) authorizes up to $1.5 billion in federal investments to promote innovative, sustainable and systemic changes that improve the overall health of Washingtonians.

The demonstration project goals are to:

• Integrate physical and behavioral health
• Convert 90 percent of Medicaid provider payments to reward quality of care
• Improve health equity so all can benefit
• Increase and improve services that support our aging population

These investments will help us spend Medicaid dollars more wisely and lead to a healthier Washington for all residents. As part of the waiver, each of Washington’s nine Accountable Communities of Health (ACHs) are engaged in mandatory and optional projects. Some ACH’s have focused their optional project on maternal and child health and care coordination, which can include services specifically for women and children with complex health and social needs.

In 2018 an amendment request was submitted to CMS and authorized to provide flexibility to improve access to high quality, clinically appropriate treatment for opioid use disorder and other substance use disorders, while incorporating quality improvement metrics to measure health outcomes.

In March 2020 a disaster waiver request was submitted to request financial flexibility, expanded eligibility, and provider and community supports related to the COVID-19 emergency response efforts. The waiver request was partially approved in April.

Health Care Transformation

Washington has a long tradition of health care delivery system reform. State agencies work with the public and private sectors toward building healthier communities through a collaborative regional approach; integrating how we meet physical and behavioral health needs so that the health system focuses on the whole person; and improving how we pay for services by rewarding quality over quantity. The Healthier Washington initiative is described in the Overview of the State.

Practice Transformation

The Department of Health (DOH) and HCA provide technical assistance and tools to support health care providers’ ability to coordinate care, increase capacity, and benefit from value-based reimbursement strategies. Practice transformation includes health care systems and facilities working toward whole person care — to incorporate teams, build relationships with patients, follow them over time, and make sure that the whole person health of that patient and their family is addressed.

The Healthier Washington Collaboration Portal is an investment area of Healthier Washington, managed in partnership by the University of Washington School of Medicine Primary Care Innovations Lab and DOH to help facilitate practice transformation. The portal is a participatory effort between members of the clinical and public health communities of Washington, providing resources to address the health needs of our communities.