wa-law.org > bill > 2025-26 > SB 5258 > Original Bill
The authority and the department shall collaborate to ensure that the department notifies the authority when individuals who are enrolled in both the income-based medicaid program and other income-based programs determined by both the department and the authority, including but not limited to the food stamp program as outlined in RCW 74.04.510, have moved out of the state. The authority and the department shall consult and seek recommendations from caseworkers and other relevant frontline staff to more effectively and efficiently identify individuals who have moved out of the state.
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The authority shall work with the federal social security administration and centers for medicare and medicaid services to clarify when and how state medicaid agencies may determine whether clients who receive social security income are no longer eligible for the state medicaid program due to out-of-state residency.
After the authority and the department receive guidance and clarification as outlined in this subsection, the department shall update procedures and provide consistent training to all caseworkers and relevant staff to ensure clients are not concurrently enrolled in multiple medicaid programs.
If the authority and the department do not receive guidance and clarity from the federal social security administration and centers for medicare and medicaid services, the state auditor shall make recommendations and provide further guidance on how the authority and the department should proceed.
The authority and the department shall develop rules to implement this section.
Beginning January 1, 2026, the authority shall amend the contracts and processes with the managed care organizations to:
Allow the state to recover premiums when the managed care enrollee has moved out of Washington state and has not received any services in the managed care service area;
Require managed care organizations that conduct business in more than one state to analyze their enrollment records on a monthly basis and identify occurrences when the enrollment records show that the same person is enrolled in more than one state medicaid program; and
Direct the managed care organizations to inform states of the results of the analysis conducted in subsection (2) of this section that the same person is concurrently enrolled in their medicaid programs and report those results to the authority on a monthly basis.
The authority shall submit an annual report by January 1, 2027, and every year thereafter for the following five years, to the governor and the relevant committees of the legislature that details:
The amount of premiums recovered from the managed care organizations under the revised contract provisions implemented under this section in the previous calendar year; and
The total number of individuals that the managed care organizations have identified as enrolled in more than one state medicaid program from the previous calendar year.
By December 31, 2031, the office of the state auditor shall conduct a performance audit of the concurrent medicaid enrollments in the state of Washington. The performance audit must examine how much the state is paying for concurrent medicaid coverage and evaluate the progress the state has made in limiting the unnecessary premiums since the 2024 performance audit report published by the Washington state auditor and make any additional recommendations to limit unnecessary premiums in the future.
The authority shall analyze the full list of medicaid enrolled client addresses through the national change of address database from the United States postal service on a quarterly basis to identify clients who have moved out of the state.
To the extent of available funds, medical care services may be provided to:
Victims of human trafficking, as defined in RCW 74.04.005, who are not eligible for medicaid under RCW 74.09.510, section 1902(a)(10)(A)(i)(VIII) of the social security act, or apple health for kids under RCW 74.09.470, who otherwise qualify for state family assistance programs under RCW 74.04.820;
Persons eligible for the aged, blind, or disabled assistance program authorized in RCW 74.62.030 and who are not eligible for medicaid under RCW 74.09.510; and
Persons eligible for essential needs and housing support under RCW 74.04.805 and who are not eligible for medicaid under RCW 74.09.510.
Enrollment in medical care services may not result in expenditures that exceed the amount that has been appropriated in the operating budget. If it appears that continued enrollment will result in expenditures exceeding the appropriated level for a particular fiscal year, the department may freeze new enrollment and establish a waiting list of persons who may receive benefits only when sufficient funds are available.
Determination of the amount, scope, and duration of medical care services shall be limited to coverage as defined by the authority, except that adult dental, and routine foot care shall not be included unless there is a specific appropriation for these services.
The authority shall enter into performance-based contracts with one or more managed health care systems for the provision of medical care services under this section. The contract must provide for integrated delivery of medical and mental health services.
The authority shall establish standards of assistance and resource and income exemptions, which may include deductibles and coinsurance provisions. In addition, the authority may include a prohibition against the voluntary assignment of property or cash for the purpose of qualifying for assistance.
Eligibility for medical care services shall commence with the date of eligibility for the aged, blind, or disabled assistance program provided under RCW 74.62.030 or the date of eligibility for the essential needs and housing support program under RCW 74.04.805.
To the extent possible, the authority must coordinate with the department of social and health services, food assistance programs for legal immigrants, state family assistance programs, and refugee cash assistance programs.
The authority shall ensure notices and letters about program eligibility sent to persons under this section who are the applicant for, or the recipient of, health care coverage meet the standards established in the plain language guidelines by the state.
The authority shall ensure that all written notices and correspondence mailed by the authority include "address service requested" on the mailing piece.