Essential worker health care

AN ACT Relating to establishing the essential worker health care 1
program; adding new sections to chapter 43.20A RCW; adding new 2
sections to chapter 48.02 RCW; creating a new section; and declaring 3
an emergency. 4
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:5
NEW SECTION. Sec. 1. (1) The legislature finds:6
(a) That there is a workforce crisis in Washington's nursing 7
homes where the majority of workers are older women and 8
disproportionately women of color and immigrants. Overwhelmingly 9
nursing home workers live at or near poverty levels;10
(b) Workers in nursing homes are essential health care workers 11
who provide hands-on personal care, supervision, nursing care 12
services, and emotional support to thousands of elderly and younger 13
people with chronic illnesses and disabilities, yet continue to 14
struggle for recognition and compensation even as the demand for 15
long-term care services increases; 16
(c) Investments in worker benefits and wages have improved 17
stability in the Washington in-home workforce by providing access to 18
affordable and high quality employee health care benefits that help 19
stem turnover; 20
S-0563.1
SENATE BILL 5344
State of Washington 69th Legislature 2025 Regular Session
By Senators Riccelli, Harris, Lovick, Cleveland, Lovelett, Liias,
Saldaña, Frame, Hasegawa, Nobles, Trudeau, Valdez, and C. Wilson
Read first time 01/17/25. Referred to Committee on Health & Long-
Term Care.
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(d) Access to high quality and affordable health care would help 1
address staff turnover, stabilize the workforce, and improve the 2
quality of nursing home care. 3
(2) Therefore, the legislature intends to address this crisis by:4
(a) Offering increased funding to nursing home operators who 5
commit to offering high quality and affordable health care to their 6
employees; 7
(b) Encouraging nursing home operators to offer health care in 8
the most cost-effective way possible, through large-scale, 9
multiemployer plans; and 10
(c) Requiring that funds appropriated for this purpose are spent 11
as intended and that these funds supplement rather than supplant 12
existing health care funding for employee health care coverage.13
NEW SECTION. Sec. 2. A new section is added to chapter 43.20A 14
RCW to read as follows: 15
(1) By July 1, 2026, the essential worker health care program 16
shall be established within the department to help provide nursing 17
home workers with high quality, affordable health coverage through 18
participating nursing home employers. The department shall distribute 19
funding through a supplemental payment to participating nursing home 20
employers and seek any necessary approvals from the centers for 21
medicare and medicaid services to provide this supplemental payment 22
as provided in section 6 of this act. The supplemental payment must 23
be distributed annually in proportion to each participating nursing 24
home employer's medicaid bed days in the previous calendar year.25
(2) To participate in the essential worker health care program, 26
employers must operate at least one nursing home licensed under 27
chapter 18.51 RCW in Washington that participates in medicaid and 28
enter into a memorandum of understanding with the department 29
committing to: 30
(a) Participate in a qualified health fund certified by the 31
office of the insurance commissioner; 32
(b) Allocate substantially all of the funds distributed through 33
this program to the qualified health fund; 34
(c) Provide documentation to the department of its spending on 35
employee health care benefits in Washington in the two years prior to 36
its entry into the program; 37
(d) Maintain spending on employee health care benefits in the 38
first year of its participation in the program at least equal to the 39
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average of its spending in the two years prior to its entry into the 1
program and maintain spending in subsequent years at least equal to 2
this level plus the consumer price index for health insurance 3
maintained by the United States bureau of labor statistics. Spending 4
to meet this requirement must flow through the certified qualified 5
health fund. For qualified health funds offered through a Taft-6
Hartley fund in which union representatives occupy at least 50 7
percent of board seats, a certification from each participating union 8
is sufficient to comply with this requirement; 9
(e) Provide the department with information concerning its 10
employee health care benefits, covered employee uptake of the 11
employer's health plan, cost to the employer and covered employees, 12
and employer retention of employees in the two years prior to its 13
entry into the program, and provide updates to this information at 14
the end of each year of participation in the program;15
(f) Demonstrate at least annually or more frequently at the 16
request of the department that it has used all of the supplemental 17
payments received through the program to significantly improve the 18
quality of employee health care benefits offered to covered 19
employees; and 20
(g) Meet any other conditions or requirements specified by the 21
department in rule to achieve the goals of this program.22
(3) Only covered employees may participate in the program. A 23
"covered employee" is any permanent employee of a company that 24
operates a participating facility who works primarily in the state of 25
Washington including, but not limited to, employees providing direct 26
care to nursing home residents; employees indirectly involved in 27
resident care; employees providing dietary, housekeeping, laundry, or 28
environmental services on location; administrative employees and 29
management; and corporate office employees, or any subcontractor of 30
such a company who works on a full-time, permanent basis in a nursing 31
home. 32
(4) The department may take any enforcement action authorized 33
under this chapter or terminate any participating employer that fails 34
to comply with the requirements established in the memorandum of 35
understanding, sections 2 and 3 of this act, and any related rules 36
adopted by the department. 37
(5) The department may adopt rules to administer and implement 38
this act. 39
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NEW SECTION. Sec. 3. A new section is added to chapter 48.02 1
RCW to read as follows: 2
(1) The office of the insurance commissioner shall annually 3
certify a proposed health care benefit arrangement as a qualified 4
health fund if it meets the requirements of this section. 5
Supplemental payments to participating employers may be disbursed by 6
the department of social and health services only to employers that 7
offer employee health care benefits solely through a qualified health 8
fund that: 9
(a) Includes at least two distinct and unrelated employers in 10
each year of the program. For the initial plan year of operation, the 11
entity seeking certification must provide sufficient information to 12
the commissioner to confirm that at least two distinct and unrelated 13
employers will be offering employee health care benefits through the 14
fund. For subsequent years, the entity seeking certification must 15
provide information showing that at least two distinct and unrelated 16
employers participated in the fund during the previous plan year;17
(b)(i) Operates or provides health coverage through a fully 18
insured multiemployer welfare arrangement or an association health 19
plan; or 20
(ii) Operates as a self-insured Taft-Hartley fund with equal 21
union and employer participation; 22
(c) For a qualified health fund operated under (b)(i) of this 23
subsection, during the previous plan year, offered benefits to at 24
least 5,000 employees in the long-term care industry in Washington 25
state. For the initial plan year of operation, the entity seeking 26
certification shall provide sufficient information to the 27
commissioner to confirm anticipated enrollment of at least 5,000 28
long-term care employees; 29
(d) Offers a benefit package that is either equivalent to an 30
affordable care act platinum plan in actuarial value, covered 31
benefits and cost sharing, or, if the plan is offered by a Taft-32
Hartley trust, a plan approved by the board of the trust;33
(e) Certifies each year that participating employers are 34
complying with the terms of the program, including the maintenance of 35
spending requirement provided in section 2(2)(d) of this act;36
(f) Except for Taft-Hartley plans, demonstrates for the initial 37
year of operation and annually that it has provided the opportunity 38
for substantive input on plan design, including covered services and 39
how they will be delivered from substantially all covered employees;40
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(g) Except for Taft-Hartley plans, demonstrates for the initial 1
year of operation and annually that it has a robust enrollment 2
process in place to ensure that covered employees fully understand 3
their benefits; and 4
(h) Complies with any other requirements determined by the 5
commissioner in rule to further the goals of the program.6
(2) The commissioner may adopt rules to administer and implement 7
this act. 8
NEW SECTION. Sec. 4. A new section is added to chapter 48.02 9
RCW to read as follows: 10
(1) The commissioner may take any enforcement action authorized 11
under RCW 48.02.080 or revoke certification for a qualified health 12
fund that fails to meet the requirements of sections 2 and 3 of this 13
act or any related rules adopted by the office of the insurance 14
commissioner. 15
(2) If the office of the insurance commissioner takes any 16
enforcement action, revokes a certification, or terminates or is 17
considering terminating a qualified health fund, the office of the 18
insurance commissioner shall notify the department of social and 19
health services. 20
NEW SECTION. Sec. 5. A new section is added to chapter 43.20A 21
RCW to read as follows: 22
(1) For employers participating in a qualified health fund that 23
loses certified qualified health fund status for noncompliance, the 24
department shall recoup any supplemental payments received under this 25
program during the period in which the qualified health fund was out 26
of compliance with the requirements established in section 3 of this 27
act and any related rules adopted by the department or the office of 28
the insurance commissioner. 29
(2) For participating employers that are terminated by the 30
department for noncompliance, the department shall recoup any 31
supplemental payments from the participating employer that was out of 32
compliance with requirements established in section 2 of this act and 33
any related rules adopted by the department for the fiscal years in 34
which the employer was out of compliance. 35
(3) The department shall establish and administer a process for 36
the recoupment of supplemental payments disbursed under the essential 37
worker health care program established under section 2 of this act.38
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(4) The recoupment process must include: 1
(a) A review and audit of expenditures by participating employers 2
and qualified health funds at least once every two years;3
(b) Written notice to employers or funds found noncompliant, 4
detailing the reasons for recoupment and providing an opportunity for 5
appeal within 30 days; 6
(c) Recovery of funds by offsetting future payments, direct 7
reimbursement to the department, or other means as determined by the 8
department in rule; and 9
(d) Reporting all recoupment activities to the legislature 10
annually, including details of amounts recovered and the basis for 11
recoupment. 12
NEW SECTION. Sec. 6. A new section is added to chapter 43.20A 13
RCW to read as follows: 14
(1) The implementation of the essential worker health care 15
program established in section 2 of this act is contingent upon the 16
approval of a state plan amendment or waiver by the centers for 17
medicare and medicaid services providing federal financial 18
participation for supplemental payments under this program.19
(2) The department shall submit the necessary state plan 20
amendment or waiver application to the centers for medicare and 21
medicaid services by July 1, 2025, and provide a report to the 22
legislature on the status of approval by no later than December 1, 23
2025. 24
(3) If the centers for medicare and medicaid services does not 25
provide approval by July 1, 2026, the department and the office of 26
the insurance commissioner shall: 27
(a) Delay implementation of the program until approval is 28
received; 29
(b) Provide an updated implementation timeline to the 30
legislature; and 31
(c) Identify and recommend potential state funding alternatives 32
to ensure compliance with the intent of this act. 33
(4) Any supplemental payments made under the program prior to 34
approval from the centers for medicare and medicaid services are 35
contingent on retroactive approval of federal matching funds or 36
subject to the recoupment process outlined in section 5 of this act.37
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NEW SECTION. Sec. 7. Section 6 of this act is necessary for the 1
immediate preservation of the public peace, health, or safety, or 2
support of the state government and its existing public institutions, 3
and takes effect immediately.4
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