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Medicaid Rates

Medicaid Rates

Building off of WSMA’s success in recent legislative sessions in increasing Medicaid reimbursement for some primary care, pediatric, and behavioral health services, the WSMA is going full throttle into the 2024 legislative session with the goal of increasing Medicaid rates across the board for all physicians in all settings to at least the equivalents paid by Medicare.

We Have an Approach to Fund Increased Medicaid Rates

The state's current low reimbursement rates are having significant effects on patient access to care.

Legislators have previously asked the WSMA to identify a new, non-general fund revenue source for a reimbursement rate increase, and in working with legislators and other experts across the country, we have developed an approach to utilize a “covered lives assessment.” 

This assessment would be applied to insurance carriers (primarily Medicaid managed care organizations) to generate revenue, mostly from the federal government, to fund an across-the-board rate increase up to at least Medicare equivalents, indexing to inflation in future years.

Strengthening Medicaid with a Covered Lives Assessment

In late January, Reps. Nicole Macri (D-43) and Marcus Riccelli (D-3) introduced House Bill 2476, WSMA-backed legislation to increase Medicaid reimbursement rates to Medicare levels. The bill establishes a covered lives assessment and allow the state to draw down federal funds and increase rates across the board for all specialties.

In spite of the extensive engagement of the physician community, which included physicians from across specialties and geographies testifying in support of HB 2476, meeting with legislators, sending hundreds of messages in support of the bill, writing letters to their local papers, and speaking directly with reporters about the importance of improving rates, we are disappointed that our proposal to increase Medicaid rates is not included in legislative budget drafts released in mid-February.

Action alert! Tell the Legislature to add the covered lives assessment to the state budget

We must continue to press this issue. House Bill 2476, the covered lives assessment legislation, is designed to be fiscally neutral to the state and will allow more Medicaid patients to get the care they need by bringing approximately $500 million annually in federal funds to Washington state. We are overdue for strengthening access to care for Medicaid enrollees and the time for action is now.

Act today: Ask your legislators in the House and Senate to add the covered lives assessment to the 2024 state operating budget.

We need your voice now. If you and your patients have been affected by the state's chronically low reimbursement rates, please take a few minutes right now to send a message to your legislators.

Health and physician groups statewide support a covered lives assessment

This is an urgent issue in all parts of Washington and the WSMA is rallying the house of medicine in our state to support this proposal. Nearly 60 health and physician groups have already signed on in support of HB 2476 and they are also working directly with legislators.

Resources to help support HB 2476

To ensure lawmakers have the physician and patient perspectives in mind, here are some resources to inform you, legislators, and the public:

  • Medicaid campaign homepage explains the reimbursement issue, as well as the impact on patients and stories from physicians who are concerned about access to care.
  • Fact sheet can be downloaded from the site and shared with anyone.
  • Medicaid patient survey gives insight into the patient experience. When they can’t get the care they need, they’re managing more pain, delayed diagnoses, and additional ED visits.

We have put significant resources toward fair rates that will increase access to care, and WSMA members and the wider physician community will receive updates regularly throughout session on our progress and on ways you can help. We’re also always happy to talk with you and hear your questions and concerns—reach out to WSMA CEO Jennifer Hanscom, Director of Government Affairs Sean Graham, or Communications Director Graham Short with any questions or requests.

Join or renew your membership today!