Medicaid service rates rise when approval and funding conditions are met

Washington must submit needed Medicaid program requests to federal officials, and the state must raise certain service rates when required conditions are met. The rates cover listed professional services, including surgery, behavioral health, maternity care, and office visits. Rate increases depend on final federal approval, any needed changes to state contracts with managed care organizations, and state funding sufficient to support the rates. Increases also depend on funds collected in the prior plan year and apply to listed services paid below the relevant Medicare rates. Washington must submit needed requests by September 1, 2030. Rate increases begin by January 1 of the second plan year after all required conditions are met.

Washington must adjust rates for listed services and study whether the increases improve Medicaid access. These duties cover the professional services listed for rate increases and access for Medicaid enrollees. The state must report results separately for managed care and fee-for-service coverage. The state must assess access using measures such as service use, provider participation, and patient surveys. Annual rate adjustments begin by January 1 of the third plan year after the conditions are met. The state must study access beginning that year and by January 1 in each of the next two years.

The Medicaid access program expires if federal officials have not given final approval by the deadline. This rule applies to the Medicaid access program and the federal approval required for it. If the program expires, the state health care authority must give written notice to affected parties and specified state officials. The expiration deadline is January 1, 2032.