Medicaid access program

AN ACT Relating to the medicaid access program; amending RCW 1
74.76.020 and 74.76.050; and amending 2025 c 359 s 18 (uncodified).2
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:3
Sec. 1. RCW 74.76.020 and 2025 c 359 s 2 are each amended to 4
read as follows: 5
(1) By September 1, ((2025)) 2030, the authority shall submit any 6
state plan amendments or waiver requests to the centers for medicare 7
and medicaid services that are necessary to implement the medicaid 8
access program established in RCW 74.76.050. 9
(2) The assessment, collection, and disbursement of funds for 10
this program shall be conditional upon: 11
(a) Final approval by the centers for medicare and medicaid 12
services of any state plan amendments or waiver requests that are 13
necessary in order to implement the applicable sections of this 14
chapter including, if necessary, waiver of the broad-based or 15
uniformity requirements as specified under section 1903 (w)(3)(E) of 16
the federal social security act and 42 C.F.R. Sec. 433.68(e);17
(b) To the extent necessary, amendment of contracts between the 18
authority and managed care organizations to implement this chapter; 19
and 20
H-2610.1
HOUSE BILL 2385
State of Washington 69th Legislature 2026 Regular Session
By Representatives Macri, Reed, Doglio, Ormsby, Salahuddin, Hill, and
Thai
Prefiled 01/09/26. Read first time 01/12/26. Referred to Committee
on Appropriations.
p. 1 HB 2385
(c) Certification by the office of financial management that 1
appropriations have been adopted that fully support the rates 2
established in RCW 74.76.030 for the upcoming fiscal year.3
Sec. 2. RCW 74.76.050 and 2025 c 359 s 6 are each amended to 4
read as follows: 5
(1) The medicaid access program is hereby created.6
(2) By January 1st of the second plan year after conditions of 7
RCW 74.76.020 are met, professional services rates for anesthesia, 8
diagnostics, intense outpatient, opioid treatment programs, emergency 9
room, inpatient and outpatient surgery, inpatient visits, low-level 10
behavioral health, maternity services, office and home visits, 11
consults, office administered drugs, vision, and other physician 12
services, for services that are not reimbursed at or above medicare 13
rates as of December 31 ((, 2024 )) st of the prior year , must be 14
increased uniformly across professional service categories by a 15
percentage of corresponding medicare rates as of December 31 ((, 16
2024)) st of the prior year , based on availability of funds in the 17
account created in RCW 74.76.040 for rate increases from collections 18
in the preceding plan year. 19
(3) By January 1st of the third plan year after the conditions of 20
RCW 74.76.020 are met, and annually thereafter, the rates for all 21
services listed in subsection (2) of this section shall be adjusted 22
using the most recently published medicare economic index available 23
at the time rates are established for the plan year.24
(4)(a) Beginning January 1st of the third plan year after the 25
conditions of RCW 74.76.020 are met and by January 1st in each of the 26
two subsequent plan years, the authority shall study the impact of 27
the professional services rate increases described in this section on 28
medicaid access. The authority shall provide information to fiscal 29
and health committees of the legislature whether these rate increases 30
have increased access for medicaid enrollees, using metrics including 31
but not limited to: 32
(i) Increases in utilization of services from licensed health 33
care providers; 34
(ii) Number of contracts with identifiable provider types 35
enrolled to provide services to medicaid enrollees;36
(iii) Patient access measures in the ((CAHPS [consumer assessment 37
of healthcare providers and systems] )) consumer assessment of 38
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healthcare providers and systems health plan surveys of managed care 1
organizations; and 2
(iv) Other external quality review metrics. 3
(b) The authority shall provide the information in a fashion that 4
disaggregates managed care organizations and fee-for-service.5
Sec. 3. 2025 c 359 s 18 (uncodified) is amended to read as 6
follows: 7
(1) This act expires if by January 1, ((2027)) 2032, the federal 8
centers for medicare and medicaid services does not provide final 9
approval of the state plan amendment or waiver requests under section 10
2 of this act. 11
(2) The Washington state health care authority must provide 12
written notice of the expiration date in subsection (1) of this 13
section to affected parties, the chief clerk of the house of 14
representatives, the secretary of the senate, the office of the code 15
reviser, and others as deemed appropriate by the authority.16
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p. 3 HB 2385