Medicaid in Washington

The Washington State Health Care Authority administers Washington Apple Health, the “brand name” for the state’s medical assistance programs, including Medicaid. HCA purchases health care for more than 2.5 million people, around a third of Washington residents, through its programs including 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.

In April 2021, 2,050,619 people in Washington had access to Medicaid services, including 876,687 children under age 19. HCA contracts with managed care organizations to provide physical and behavioral health care services. As of April 2021, around 85 percent of Apple Health clients were enrolled in a managed care plan, the rest in fee-for-service. (HCA website, May 2021)

The state Title V program works in partnership with HCA in many ways. Both agencies provide staff to common working groups that focus on specific efforts to improve women’s and children’s health, including children and youth with special health care needs. We work 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. The CYSHCN Director participates in the state Title XIX Advisory Committee.

The Title V program maintains agreements with HCA to: 1) reimburse expenditures made by Title V program that are eligible for Medicaid coverage, 2) help us determine the reach and effectiveness of programs and assist us in determining whether people receive their appropriate services, and 3) provide for data sharing between the departments. Our Title V program agreements with HCA are included in Section IV of this application and are described below.

Medicaid Section 1115 Waiver – Medicaid Transformation Project

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 are engaged in mandatory and optional projects. Some ACHs 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 request was approved in part.

In January 2021 a one-year extension of authorities was requested to extend the project to a sixth year. This additional time has been requested due to COVID-19 disruptions.