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Medicaid Rates

Medicaid Rates

The number of Medicaid enrollees has grown to 2 million people in Washington state, demonstrating a significant scale of need. But access to coverage doesn’t equal access to care. While Washington has made coverage available to more people, reimbursement rates are so abysmal that many, if not most, practices simply cannot afford to see the number of Medicaid patients who need care.

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 asking the Washington Legislature to increase 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

During the 2024 state legislative session, 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. The WSMA’s financial modeling indicated that the benefit to the state would be nearly $500 million, which would have been sufficient to get Medicaid rates up to Medicare levels and would provide an ongoing source of revenue.

With a short 60-day legislative session, we knew passage would require an unprecedented effort. With experts in finance, state budgeting, and advocacy, the WSMA helped legislators see how low rates hurt access to care across specialties and regions. Hundreds of WSMA members from across the state sent in letters of support, provided stories, briefed reporters, and much more.

It’s clear that tenacity will also be required. While we had good engagement on the bill by legislators and stakeholders, ultimately lawmakers did not include funding in their supplemental budget. The WSMA will spend the upcoming months working with these stakeholders and legislators to address their concerns, build their allyship, and implement a lasting fix for Medicaid rates.

What's next

Next year, the Legislature will develop a new biennial state budget, but make no mistake, our work is already underway. WSMA staff, leadership, and membership all have crucial roles to play in educating lawmakers about the necessity of improving Medicaid reimbursement rates for all specialties and all regions. The WSMA will have more information in the weeks ahead on concrete actions the physician community can take during this interim period to advocate and educate. All Medicaid patients deserve the same access to whole-body care that Medicare and privately insured patients receive. It’s time for the state to stop denying essential care to 2 million Washington residents.

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