wa-law.org > bill > 2025-26 > SB 6173 > Original Bill

SB 6173 - Apple health employer assess

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Section 1

  1. Beginning in the calendar year following the community engagement implementation year, an apple health employer assessment is imposed on apple health employers. The assessment equals the total member months for an apple health employer during the preceding calendar year, multiplied by 100 percent of the medicaid fair share capitation amount.

  2. The apple health employer assessment shall be collected on a quarterly basis in a form and manner required by the employment security department that is consistent with the collection of premiums under chapter 50A.10 RCW. One-fourth of the apple health employer assessment shall be remitted by the apple health employer to the department each calendar quarter.

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    1. By March 15th of the calendar year following the community engagement implementation year and by March 15th of every year thereafter, the department of social and health services shall calculate the apple health employer assessment for each apple health employer with data provided by the other administering agencies.

    2. The administering agencies shall enter into data-sharing agreements to fulfill the requirements of this section.

  4. By April 1st of the calendar year following the community engagement implementation year and by April 1st every year thereafter, the employment security department shall notify apple health employers of their apple health employer assessment obligation for the current calendar year, which shall be remitted to the employment security department as provided in subsection (2) of this section.

  5. Moneys collected under this section must be deposited in the state health care affordability account under RCW 43.71.130. Moneys in the account may be spent only after appropriation.

  6. The definitions in this subsection apply to this section unless the context clearly requires otherwise.

    1. "Administering agencies" means the employment security department, department of social and health services, and the health care authority.

    2. "Community engagement implementation year" means the first calendar year in which the community engagement requirements under 42 U.S.C. Sec. 1396a are implemented in the state of Washington as determined by the health care authority.

    3. "Employer" has the same meaning as provided in RCW 50A.05.010.

    4. "Employed" means a qualified individual who works not less than 80 hours per month for an apple health employer.

    5. "Medicaid fair share capitation rate" means the composite capitation rate for the medicaid expansion population in the community engagement implementation year, and each calendar year thereafter, using the most recent managed care organization capitation rates from the health care authority, as certified by the contracted actuary. The medicaid fair share capitation rate includes both the physical health rate component and the behavioral health rate component.

    6. "Apple health employer" means an employer subject to the premiums imposed under chapter 50A.10 RCW with one or more employed qualified individuals concurrently enrolled in medicaid in the preceding calendar year, as determined by the administering agencies. An "apple health employer":

      1. Does not include:

(A) Any employer with fewer than 100 employees employed in the state;

(B) The federal government;

(C) The state, state institutions, and state agencies; and

(D) Any unit of local government including, but not limited to, a county, city, town, municipal corporation, quasi-municipal corporation, or political subdivision.

    ii. In the case of a franchise, means the franchisor rather than the franchisee. For the purpose of this subsection, "franchise," "franchisee," and "franchisor" have the same meanings as defined in chapter 19.100 RCW.

g. "Member month" means each month a qualifying individual works for an apple health employer.

h. "Qualifying individual" means an individual enrolled in medicaid who meets community engagement requirements under 42 U.S.C. 1396a, as determined by the health care authority.

Section 2

  1. The state health care affordability account is created in the state treasury. Moneys in the account may be spent only after appropriation. Expenditures from the account may only be used for premium and cost-sharing assistance programs established in RCW 43.71.110 and for health care programs for low-income individuals.

  2. The following funds must be deposited in the account:

    1. Any grants, donations, or contributions of money collected for purposes of the premium assistance or cost-sharing reduction programs established in RCW 48.43.795;

    2. Any federal funds received by the health benefit exchange pursuant to RCW 43.71.120;

    3. Any additional funding specifically appropriated to the account; and

    4. Any revenue collected from the apple health employer assessment as outlined in section 1 of this act.

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