The Washington State Legislature adjourned its 2023 budget session in April – after passing more than 550 bills, a $69.2 billion operating budget and a $8.6 billion capital budget. Our community health center priorities were largely supported this session, and several changes and investments were made in the healthcare system. Below is an overview of our legislative priorities, as well as brief summaries of legislation and investments in other areas that impact community health (skip to summaries).
Joint Legislative Priorities
$49.9 million for expanded health coverage solutions: The Legislature invested $49.9 million to cover undocumented individuals under 138 percent of the federal poverty level through a Medicaid comparable program, starting July 1, 2024. The structure of this program allows the Legislature to add additional populations in the future. We anticipate the Legislature will continue to contemplate ways to strengthen and expand this coverage. In addition, the operating budget includes $25 million to fully fund subsidies for individuals purchasing coverage on the Health Benefit Exchange, including newly eligible individuals who were previously unable to access coverage on the Health Benefit Exchange due to their immigration status. To reach this newly eligible population, the Legislature is dedicating $3 million towards community-based outreach and engagement.
$20 million for loan repayment: The final budget also includes significant investments in the Washington Student Achievement Council’s loan repayment programs, which are key to recruiting and retaining healthcare professionals who reflect the communities health centers serve. The legislature provided $10 million to increase the Washington Health Corps Loan Repayment program and an additional $10 million in the Behavioral Health Loan Repayment program.
$5.2 million for dental capital projects: The final capital budget fully funds all seven of our 2023 dental access projects. The Legislature has been funding capital projects for community health center dental clinics since 2017, expanding access to more than 115,000 patients. The seven projects below will expand access even further - reaching more than 12,400 additional people in rural, Tribal, and urban communities.
Columbia Valley Community Health: Funding will establish a new dental clinic.
HealthPoint: Funding will allow for a dental expansion to their medical clinic in White Center.
Lake Roosevelt Community Health Center (LRCHC – Inchelium and Keller): Funding will replace aging and add new dentist chairs at the tribally-owned LRCHC Inchelium and Keller clinics.
Neighborcare: Funding will fully renovate the dental facility in their 45th Street Clinic.
Peninsula Community Health Services: Funding will allow for new dental equipment and an emergency power generator.
Seattle Indian Health Board: Funding will expand dental services, doubling current capacity.
Investments and Legislation that Impact Community Healthcare
Several other changes and investments were made this session that impact community health centers and the patients they served. Below are brief summaries of some of the changes that occurred in policy areas relevant to community health. Click on the links below to jump to different topics.
BEHAVIORAL HEALTH
The Legislature explored ways to stabilize and expand the behavioral health workforce through bills such as HB 1724, which aims to ease licensure and certification barriers for behavioral health professionals and HB 1069 which made Washington a part of the interstate mental health counselor licensure compact. The Legislature also created two new professions, with SB 5189 establishing behavioral health support specialists and SB 5555 formally creating peer support specialists.
ORAL HEALTH
In oral health, the Legislature’s efforts were also focused on expanding the dental workforce pipeline. Following more than a decade of intense debate, legislation establishing the practice of dental therapy at community health centers (HB 1678) passed into law. Washington’s Community health centers now join tribal communities as the only authorized practices for this new class of oral health professionals. The capital budget invested $12.5 million in Pacific Northwest University School of Dentistry’s student learning collaborative and teaching dental program. Funding from the operating budget also expanded the Dental Therapy Education program at Skagit Valley College.
MATERNAL AND REPRODUCTIVE HEALTH
In SB 5581, the Legislature directed the Office of the Insurance Commissioner to prepare a report outlining strategies to reduce or eliminate deductibles and other forms of cost sharing for maternal support strategies and postpartum care, including recommendations and cost estimates for legislation. Additionally, it invested $300,000 in grants for community health centers to purchase and dispense long-acting reversible contraceptives. In response to the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, the legislators also passed HB 1155, to enhance privacy protections for consumer health data, and SB 5242, which prohibits cost sharing for abortion services. ESHB 1469 was passed to establish protections for individuals receiving gender-affirming treatment and reproductive health services in Washington.
PHARMACY AND PRESCRIPTION MEDICATION ACCESS
To increase access and affordability, SB 5279 capped out-of-pocket costs for insulin at $35 for a 30-day supply. The Legislature also created a new Treasury account to support the state’s HIV outreach and treatment programs with revenue generated by pharmaceutical rebates.
TELEHEALTH AND DIGITAL EQUITY
The Legislature continues to evaluate the promise of telehealth. SB 5036 extends, until July 1, 2024, the ability for a doctor-patient relationship for non-behavioral healthcare services to be established via audio-video technology. After July 1, 2024, the relationship must be established via an in-person appointment. This increased flexibility allows patients to seek care, contact a provider, and establish a care plan remotely as Washington transitions out of the COVID-19 public health emergency.
The operating budget invests $30 million in the Digital Navigator Program, which provides devices and technical skills building to community members, including English-language learners, Medicaid clients, low-income populations, and seniors.
SCHOOL-BASED HEALTH
The Legislature demonstrated support for school-based health programs through HB 1622, which updates state grant programs to provide extensive programs and services for students experiencing homelessness. Permitted expenditures of the grant funding include academic services, basic needs supports, wrap-around services, employment supports, and out-of-school enrichment activities. The operating budget maintained $1.8 million for the Department of Health to continue its school-based health center grant program and increase access to healthcare services in school- or academic-settings.
SOCIAL DETERMINANTS OF HEALTH
The Legislature made significant investments in addressing food insecurity issues. HB 1784 invested $28 million in food security programs at the Department of Social and Health Services and the Department of Agriculture, while HB 1238 requires the Superintendent of Public Instruction to establish a free school meal program for public schools whose student body consists at least 30 percent of students eligible for free and reduced price lunch programs.
HB 1177 establishes a dedicated Missing and Murdered Indigenous Women and Persons unit within the Office of the Attorney General to assist local law enforcement in investigating cold cases, with a focus on culturally attuned and trauma-informed investigative practice. SB 5134 requires the Department of Corrections to create individualized discharge plans for individuals transitioning from incarceration back into the community, which includes things like securing identification documents, applying for public benefits, and access to prescription medications and SUD and mental health treatments.
The Legislature also invested $49.2 million in a new eligibility and enrollment system that will consolidate enrollment in Apple Health programs, basic food, childcare, and cash assistance programs.