Medicaid concurrent enroll.

AN ACT Relating to implementing state auditor recommendations for 1
reducing improper medicaid concurrent enrollment payments; amending 2
RCW 74.09.035; and adding new sections to chapter 74.09 RCW.3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
NEW SECTION. Sec. 1. A new section is added to chapter 74.09 5
RCW to read as follows: 6
The authority and the department shall collaborate to ensure that 7
the department notifies the authority when individuals who are 8
enrolled in both the income-based medicaid program and other income-9
based programs determined by both the department and the authority, 10
including but not limited to the food stamp program as outlined in 11
RCW 74.04.510, have moved out of the state. The authority and the 12
department shall consult and seek recommendations from caseworkers 13
and other relevant frontline staff to more effectively and 14
efficiently identify individuals who have moved out of the state.15
NEW SECTION. Sec. 2. A new section is added to chapter 74.09 16
RCW to read as follows: 17
(1)(a) The authority shall work with the federal social security 18
administration and centers for medicare and medicaid services to 19
clarify when and how state medicaid agencies may determine whether 20
S-0561.1
SENATE BILL 5258
State of Washington 69th Legislature 2025 Regular Session
By Senators Gildon, Braun, Christian, Fortunato, MacEwen, Nobles, and
J. Wilson
Read first time 01/14/25. Referred to Committee on Health & Long-
Term Care.
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clients who receive social security income are no longer eligible for 1
the state medicaid program due to out-of-state residency.2
(b) After the authority and the department receive guidance and 3
clarification as outlined in this subsection, the department shall 4
update procedures and provide consistent training to all caseworkers 5
and relevant staff to ensure clients are not concurrently enrolled in 6
multiple medicaid programs. 7
(c) If the authority and the department do not receive guidance 8
and clarity from the federal social security administration and 9
centers for medicare and medicaid services, the state auditor shall 10
make recommendations and provide further guidance on how the 11
authority and the department should proceed. 12
(2) The authority and the department shall develop rules to 13
implement this section. 14
NEW SECTION. Sec. 3. A new section is added to chapter 74.09 15
RCW to read as follows: 16
(1) Beginning January 1, 2026, the authority shall amend the 17
contracts and processes with the managed care organizations to:18
(a) Allow the state to recover premiums when the managed care 19
enrollee has moved out of Washington state and has not received any 20
services in the managed care service area; 21
(b) Require managed care organizations that conduct business in 22
more than one state to analyze their enrollment records on a monthly 23
basis and identify occurrences when the enrollment records show that 24
the same person is enrolled in more than one state medicaid program; 25
and 26
(c) Direct the managed care organizations to inform states of the 27
results of the analysis conducted in subsection (2) of this section 28
that the same person is concurrently enrolled in their medicaid 29
programs and report those results to the authority on a monthly 30
basis. 31
(2) The authority shall submit an annual report by January 1, 32
2027, and every year thereafter for the following five years, to the 33
governor and the relevant committees of the legislature that details:34
(a) The amount of premiums recovered from the managed care 35
organizations under the revised contract provisions implemented under 36
this section in the previous calendar year; and 37
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(b) The total number of individuals that the managed care 1
organizations have identified as enrolled in more than one state 2
medicaid program from the previous calendar year. 3
(3) By December 31, 2031, the office of the state auditor shall 4
conduct a performance audit of the concurrent medicaid enrollments in 5
the state of Washington. The performance audit must examine how much 6
the state is paying for concurrent medicaid coverage and evaluate the 7
progress the state has made in limiting the unnecessary premiums 8
since the 2024 performance audit report published by the Washington 9
state auditor and make any additional recommendations to limit 10
unnecessary premiums in the future. 11
NEW SECTION. Sec. 4. A new section is added to chapter 74.09 12
RCW to read as follows: 13
The authority shall analyze the full list of medicaid enrolled 14
client addresses through the national change of address database from 15
the United States postal service on a quarterly basis to identify 16
clients who have moved out of the state. 17
Sec. 5. RCW 74.09.035 and 2020 c 136 s 4 are each amended to 18
read as follows: 19
(1) To the extent of available funds, medical care services may 20
be provided to: 21
(a) Victims of human trafficking, as defined in RCW 74.04.005, 22
who are not eligible for medicaid under RCW 74.09.510, section 23
1902(a)(10)(A)(i)(VIII) of the social security act, or apple health 24
for kids under RCW 74.09.470, who otherwise qualify for state family 25
assistance programs under RCW 74.04.820; 26
(b) Persons eligible for the aged, blind, or disabled assistance 27
program authorized in RCW 74.62.030 and who are not eligible for 28
medicaid under RCW 74.09.510; and 29
(c) Persons eligible for essential needs and housing support 30
under RCW 74.04.805 and who are not eligible for medicaid under RCW 31
74.09.510. 32
(2) Enrollment in medical care services may not result in 33
expenditures that exceed the amount that has been appropriated in the 34
operating budget. If it appears that continued enrollment will result 35
in expenditures exceeding the appropriated level for a particular 36
fiscal year, the department may freeze new enrollment and establish a 37
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waiting list of persons who may receive benefits only when sufficient 1
funds are available. 2
(3) Determination of the amount, scope, and duration of medical 3
care services shall be limited to coverage as defined by the 4
authority, except that adult dental, and routine foot care shall not 5
be included unless there is a specific appropriation for these 6
services. 7
(4) The authority shall enter into performance-based contracts 8
with one or more managed health care systems for the provision of 9
medical care services under this section. The contract must provide 10
for integrated delivery of medical and mental health services.11
(5) The authority shall establish standards of assistance and 12
resource and income exemptions, which may include deductibles and 13
coinsurance provisions. In addition, the authority may include a 14
prohibition against the voluntary assignment of property or cash for 15
the purpose of qualifying for assistance. 16
(6) Eligibility for medical care services shall commence with the 17
date of eligibility for the aged, blind, or disabled assistance 18
program provided under RCW 74.62.030 or the date of eligibility for 19
the essential needs and housing support program under RCW 74.04.805.20
(7) To the extent possible, the authority must coordinate with 21
the department of social and health services, food assistance 22
programs for legal immigrants, state family assistance programs, and 23
refugee cash assistance programs. 24
(8) The authority shall ensure notices and letters about program 25
eligibility sent to persons under this section who are the applicant 26
for, or the recipient of, health care coverage meet the standards 27
established in the plain language guidelines by the state.28
(9) The authority shall ensure that all written notices and 29
correspondence mailed by the authority include "address service 30
requested" on the mailing piece.31
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