The Washington State Legislature concluded their short 60-day 2024 session on March 7th. The legislature passed roughly 340 bills, two of which were the $7.3 billion supplemental operating budget and the $1.3 billion supplemental capital budget.
Washington state’s Community Health Center (CHC) priorities were almost fully funded and included support for Apple Health expansion for the undocumented, expansion of school-based health centers (SBHCs), and expansion of dental capital projects.
Below is a review of how our priorities were met as well as summaries on key investments in other areas that impact community health and primary care.
2024 Joint Legislative Priorities
The legislative priorities of WA’s CHCs are created in partnership between the Community Health Network of Washington (CHNW) and the Washington Association for Community Health (the Association) in collaboration with all of WA’s 27 CHCs.
Apple Health Expansion
Our first priority for the 2024 session was to increase the investment in Apple Health expansion to meet the demand for undocumented individuals in our state. In last year’s session, the legislature took an important first step to expand Apple Health to all at or below 138% of the federal poverty level, regardless of immigration status. At that time, they invested $49.5 million; however, this initial investment does not adequately meet the need.
The legislature gave $28.4 million for administrative support and expansion of the program, which highlights the commitment to insure everyone in the state.
School-Based Health Centers
Our next priority for the 2024 session to expand SBHC programs and services. SBHCs provide essential services in over 70 schools to ensure access to care. These centers integrate medical, behavioral, dental care, and more, all on or nearby school campuses. This ensures that kids miss less school, parents miss less work, and students get the care they need.
CHNW and the Association, in partnership with the Washington School-Based Health Alliance, asked the legislature to invest $3.36 million in the operating budget to expand funding for the Department of Health (DOH) SBHC program and $2 million in capital funding for eight SBHC projects, six of which would be run by CHCs.
The legislature provided $500 thousand in increased funding to expand the SBHC program in the operating budget through five grants of $100 thousand each. The capital budget request was fully funded at $2 million.
Dental Capital
Our last priority for the 2024 session was to expand capital investments in community dental clinics around the state. Since 2017, the legislature has invested in 43 community dental clinics, but still more than 1.2 million Apple Health enrollees are expected to go without essential dental care this year.
We asked the legislature to invest $452 thousand in capital funding for new and expanded oral health facilities at three CHCs: CHAS Health, Community Health Center of Snohomish County, and Moses Lake Community Health Center. All $452 thousand was funded in the capital budget.
Legislation and Investments that Impact Community Health
The legislature made many other investments and passed legislation on issues that impact CHCs and the communities they serve. Below are short summaries of some of that legislation and its intended impact. A legend of abbreviations relating to bills is at the end of this post.
Behavioral Health
This session focused on assisting behavioral health providers by addressing several workforce challenges and expanding substance use disorder treatment.
Workforce
SHB 2247 will allow agency-affiliated counselors (AACs) to practice in Federally Qualified Health Centers (FQHCs) beginning January 1st, 2028. It also creates a psychology associate license and removes the practice limitation for Substance Use Disorder Professional Trainees (SUDPTs).
HB 1946 will create the Washington health corps behavioral health scholarship program.
SUD
2SSB 6228 directs Behavioral Health Administrations (BHAs) to submit inpatient nonconsensual transfer/discharge policies to DOH in an effort to adopt a model policy; they also must provide treatment education to patients seeking information on opioid use disorder (OUD) and alcohol use disorder (AUD). The bill also directs the Washington State Health Care Authority (HCA) to convene a workgroup to develop recommendations to streamline authorization for inpatient SUD treatment.
SHB 1877 focused on improving the behavioral and SUD system for better coordination with tribal communities. The newly passed law allows county and tribal attorneys to access close court records under the Involuntary Treatment Act (ITA). The attorney representing the tribe can intervene in ITA hearings involving tribal matters. This bill can protect tribal members in non-tribal behavioral health and SUD systems.
Budget Outlook
The supplemental budget also housed some important investments in behavioral health, including $1 million for two street medicine pilot programs in Seattle and Spokane. The programs aim to address a lack of access to behavioral health treatment for those living in homeless encampments by providing medical, SUD, and case management services.
Workforce
Supplementing the workforce continues to be a priority for the legislature, as shown by their focus on licensure, training programs, and assisting providers currently caring for our communities.
Apprenticeship and training programs:
Two new apprenticeship programs were introduced - an Allied Health Professions Career and Technical Education Program run by public schools ESHB 2236, and a Native American apprenticeship assistance program (HB 2019).
The HCA received $56.1 million to create and implement a multidisciplinary graduate medical education training program.
Area Health Education Centers (AHECs) were also expanded in the budget, receiving $426,000 for two new AHECs to recruit, train, and retain health care professionals in rural and underserved areas.
Licenses and certifications: The legislature introduced a new medical assistant (MA)-EMT certification (HB 1907) and expanded who can receive professional licenses (HB 1889).
Maternal & Reproductive Health
Improving maternal health outcomes was also a key focus. SB 5580 will help improve maternal health outcomes through various pathways, including increasing the federal poverty level for Apple Health eligibility for pregnant or postpartum person to 210% and directing HCA to create a post-delivery and transitional care program for individuals with SUD.
The Legislature continued discussion on protecting providers and individuals when it comes to providing and receiving reproductive and gender-affirming health care. HB 1954 aligned language protecting health care providers providing reproductive health from the denial of licensure under the Uniform Disciplinary Act. HB 2115 allows providers to put their national practitioner identification number or clinic name on prescription abortion medication instead of their own name.
Pharmacy
Pharmacy conversations were focused on affordability of prescription drugs and accessibility to pharmacy services. The legislature passed HB 1979, which caps cost-sharing for corticosteroid inhalers and epinephrine autoinjectors at $35 a month, expanding upon last year’s insulin cap.
The legislature also took steps to regulate pharmacy benefit managers (PBMs) through SB 5213. The bill prohibits PBMs from reimbursing a network pharmacy less than the price established in the contract between the PBM and the payer.
Telehealth
Much of the focus of telehealth during the legislative session was formalizing and making permanent temporary policies from the COVID-19 pandemic. ESSB 5481 enacts the Uniform Law Commission’s uniform telehealth act, which eases barriers for out-of-state providers to provide telehealth services to patients in Washington.
SB 5821 creates a standard for establishing a provider-patient relationship for audio-only telehealth. It requires patients to have at least one in-person or audio-visual telehealth visit within the past three years with the provider with audio-only telehealth services, a provider at the same medical group, clinic, or integrated delivery system, or the provider who referred the patient to the provider with audio-only telehealth.
Coverage & Affordability
Coverage & Affordability is marked by passed and not passed bills. HB 1957 codified preventative services without cost sharing, required in the Affordable Care Act (ACA), into state law to protect against lawsuits threatening these services at a federal level.
However, bills like SJM 8006 did not pass. The bill would have petitioned the federal government to create a universal health care system, to ease barriers for WA state to create a single payer system, and/or grant WA the necessary waivers to create a universal health care system.
Housing
This year’s housing bills focused on affordability and expanding funding to develop more affordable housing units around the state. However, many were unsuccessful.
Some that did not pass include ESHB 2114, which proposed various tenant protections and landlord resources in an effort to keep people housed. E2SHB 2160, which would have promoted the development of community and transit centered housing. HB 2276 would have created a real estate excise tax that would take funds for property sales and invest them in various affordable housing accounts (like the Housing Trust Fund and Apple Health & Homes). These bills would have helped expand affordable housing, which would significantly impact the health outcomes of some of most vulnerable communities that health centers serve.
However, HB 1929 passed, which will create a program of two facilities of 6-10 beds for young adults exiting inpatient behavioral health treatment and who are at risk of homelessness. Young adults 18-24 can stay in these transitional homes for 90 days, allowing them to secure long-term housing and make a plan to return to their communities.
For your reference, here is a legend of key terms/abbreviations. More can be found here:
· HB: House Bill
· SB: Senate Bill
· SHB or SSB: Substitute House/Senate Bill
· SSHB or 2SSB: Second Substitute House/Senate Bill
· ESSHB E2SSB: Engrossed Second Substitute House/Senate Bill
· SJM: Senate Joint Memorial