Notice of House Passage for Substitute House Bill 1392 AMS ENGR S2795.E -10 Year Analysis Complete

Office of the Governor / Office of Financial Management sent this bulletin at 04/23/2025 02:02 PM PDT

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SHB 1392 AMS ENGR S2795.E, titled AN ACT Relating to creating the medicaid access program, has been passed by the House of Representatives. The Office of Financial Management has identified this bill as requiring a ten-year projection of increased cost to the taxpayers or affected fee payers.

Ten-year projection:

Fiscal
Year

Covered Lives Assessment

2026

2027

$89,251,000

2028

$185,567,187

2029

$185,567,187

2030

$185,567,187

2031

$185,567,187

2032

$185,567,187

2033

$185,567,187

2034

$185,567,187

2035

$185,567,187

Total:

$1,573,788,496

Office of Insurance Commissioner:

Section 3(1)(a) requires all health carriers to pay an annual covered lives assessment beginning January 1st of the plan year following the final approval by CMS. For assessments due the first plan year, the OIC is required to access a per member per month assessment of $0.50 per covered life on health carriers. Based on 2024 annual financial statements filed with OIC by domestic health carriers, which includes information on covered lives for the fully insured commercial market, and December 2024 enrollment data reported by foreign health carriers, and limiting the assessment to 2.3 million member months per carrier, there were 14,128,375 member months covered under a fully insured individual or group health plan in CY2024. Assuming, for purposes of this fiscal note, that $0.50 per covered life will be assessed and that the number of covered lives for CY2026 will remain the same as CY2024, estimated revenue of $7,064,187 (14,128,375 covered lives x $0.50) will be collected in the first year. The number of covered lives will be captured from health carriers via the CY2026 insurance premium tax return, which is due in March 2027. OIC will then calculate and bill health carriers for the first plan year with a due date of July 2027.

Section 3(1)(b) requires that each year, on or before May 15th, HCA must determine the covered lives assessment for the calendar year. Section 3(2)(b) limits the assessments to the first 2.3 million member months of fully insured lives per health carrier. For each health carrier, the assessment shall apply to member months of all group health plan lives first, followed by member months of individual health plan lives. The HCA is unable to provide the amount needed to fund the professional services rate increases for CY2027 and beyond at this time. For purposes of this fiscal note, the OIC assumes the same assessment as the first plan year.

Wash State Health Care Authority:

Section 3: All health carriers and Managed Care Organizations (MCOs) will pay an assessment beginning January 1 of the year following the approval by Centers for Medicare and Medicaid Services (CMS).

For health carriers, the first year covered lives assessment is set at $0.50 per covered life. Subsequent assessments shall be made by the Health Care Authority (HCA) by May 15 each year. The covered lives assessment shall apply to the health carrier group plan lives followed by individual health plan lives, applicable to the first 2,300,000 member months within the group plan then individual plan.

For MCOs, the first plan year, HCA will assess a per member per month assessment of $16 for MCOs. On or before May 15 of the first plan year and on or before May 15 of each subsequent year, HCA will determine the assessment rate necessary to fund the professional services rate increase. HCA will notify MCOs annually of the estimated assessment for the upcoming year. Payment collections are to be made no more frequently than quarterly.

Assessment fees are applied to the first 2,300,000 member months per MCOs. Payments from MCOs are due within 45 days of the payment schedule determined by HCA, with interest accrued on the amounts received after the 45-day period.

Assumptions are based on CMS approval not being provided until sometime in calendar year 2026, resulting in Plan Year 1 starting January 1, 2027.

HCA Impact:

The bill requires the Health Care Authority (HCA) and the Office of the Insurance Commissioner (OIC) to collect covered lives assessment from Managed Care Organizations (MCO) and commercial health plans. The assessment is capped at 2,300,000 member months per plan. The revenue is determined by multiplying member months by $16 (MCOs) and $0.50 (commercial plans) for the initial year. HCA assumes that the assessment on Medicaid MCOs would be included as part of the non-benefit component of the MCO rates effective January 2027. MCOs will pay the assessment to HCA which will be deposited into a designated account with the state Treasurer. This revenue is intended to fund the rate increase for Apple Health professional services performed. It is unknown how the assessment rate may change over time.

Assumptions:

The total collected amount will change every year based on changes in the assessment fee that are driven by:

• Changes in the client caseload/enrollments.

• Recalculation of the assessment fee based on funding needs for the professional rate increase.

• Remaining fund balance available to pay the rates.

HBE Impacts:

Indeterminate. The assessments for health carriers applies to the first 2,300,000 member months per health carrier, with group health plan lives being charged the assessment before individual health plans, like those offered on the Exchange. It is unknown how this assessment would impact premiums for qualified health plans (QHP) offered on the exchange, and the number of exchange customers the assessment would apply to will likely differ by carrier so any premium impacts would be different by carrier. Any increase to premiums would be subject to the two percent premium tax the Exchange earns on QHP enrolled through Washington Healthplanfinder which would be deposited to the Health Benefit Exchange Account in the state treasury.

Ten-year projection prepared in consultation with the following agencies:

The following legislators voted yea:

Representative Sharon Tomiko Santos
Democrat
(360) 786-7944
sharontomiko.santos@leg.wa.gov

Representative Timm Ormsby
Democrat
(360) 786-7946
timm.ormsby@leg.wa.gov

Representative Larry Springer
Democrat
(360) 786-7822
larry.springer@leg.wa.gov

Representative Debra Entenman
Democrat
(360) 786-7918
debra.entenman@leg.wa.gov

Representative Roger Goodman
Democrat
(360) 786-7878
roger.goodman@leg.wa.gov

Representative Joe Fitzgibbon
Democrat
(360) 786-7952
joe.fitzgibbon@leg.wa.gov

Representative Brianna Thomas
Democrat
(360) 786-7978
THOMAS_BR@leg.wa.gov

Representative Cindy Ryu
Democrat
(360) 786-7880
cindy.ryu@leg.wa.gov

Representative Steve Tharinger
Democrat
(360) 786-7904
steve.tharinger@leg.wa.gov

Representative Laurie Jinkins
Democrat
(360) 786-7930
laurie.jinkins@leg.wa.gov

Representative Sharon Wylie
Democrat
(360) 786-7924
sharon.wylie@leg.wa.gov

Representative Gerry Pollet
Democrat
(360) 786-7886
gerry.pollet@leg.wa.gov

Representative Steve Bergquist
Democrat
(360) 786-7862
steve.bergquist@leg.wa.gov

Representative Jake Fey
Democrat
(360) 786-7974
jake.fey@leg.wa.gov

Representative Monica Jurado Stonier
Democrat
(360) 786-7872
monica.stonier@leg.wa.gov

Representative Mia Gregerson
Democrat
(360) 786-7868
mia.gregerson@leg.wa.gov

Representative Lillian Ortiz-Self
Democrat
(360) 786-7972
lillian.ortiz-self@leg.wa.gov

Representative Strom Peterson
Democrat
(360) 786-7950
strom.peterson@leg.wa.gov

Representative Adison Richards
Democrat
(360) 786-7964
RICHARDS_AD@leg.wa.gov

Representative Shelley Kloba
Democrat
(360) 786-7900
shelley.kloba@leg.wa.gov

Representative Beth Doglio
Democrat
(360) 786-7940
beth.doglio@leg.wa.gov

Representative Nicole Macri
Democrat
(360) 786-7826
nicole.macri@leg.wa.gov

Representative Kristine Reeves
Democrat
(360) 786-7830
kristine.reeves@leg.wa.gov

Representative Sharlett Mena
Democrat
(360) 786-7996
sharlett.mena@leg.wa.gov

Representative Lisa Callan
Democrat
(360) 786-7876
lisa.callan@leg.wa.gov

Representative Dave Paul
Democrat
(360) 786-7914
dave.paul@leg.wa.gov

Representative Mari Leavitt
Democrat
(360) 786-7890
mari.leavitt@leg.wa.gov

Representative Melanie Morgan
Democrat
(360) 786-7906
melanie.morgan@leg.wa.gov

Representative Lauren Davis
Democrat
(360) 786-7910
lauren.davis@leg.wa.gov

Representative Debra Lekanoff
Democrat
(360) 786-7800
debra.lekanoff@leg.wa.gov

Representative My-Linh Thai
Democrat
(360) 786-7926
my-linh.thai@leg.wa.gov

Representative Amy Walen
Democrat
(360) 786-7848
amy.walen@leg.wa.gov

Representative Davina Duerr
Democrat
(360) 786-7928
davina.duerr@leg.wa.gov

Representative Alex Ramel
Democrat
(360) 786-7970
alex.ramel@leg.wa.gov

Representative David Hackney
Democrat
(360) 786-7956
David.Hackney@leg.wa.gov

Representative Tarra Simmons
Democrat
(360) 786-7934
Tarra.Simmons@leg.wa.gov

Representative Dan Bronoske
Democrat
(360) 786-7958
Dan.Bronoske@leg.wa.gov

Representative Jamila Taylor
Democrat
(360) 786-7898
Jamila.Taylor@leg.wa.gov

Representative Liz Berry
Democrat
(360) 786-7860
Liz.Berry@leg.wa.gov

Representative April Berg
Democrat
(360) 786-7892
April.Berg@leg.wa.gov

Representative Mary Fosse
Democrat
(360) 786-7864
Mary.Fosse@leg.wa.gov

Representative Brandy Donaghy
Democrat
(360) 786-7804
Brandy.Donaghy@leg.wa.gov

Representative Chris Stearns
Democrat
(360) 786-7858
Chris.Stearns@leg.wa.gov

Representative Julio Cortes
Democrat
(360) 786-7840
Julio.Cortes@leg.wa.gov

Representative Darya Farivar
Democrat
(360) 786-7818
Darya.Farivar@leg.wa.gov

Representative Julia Reed
Democrat
(360) 786-7814
Julia.Reed@leg.wa.gov

Representative Chipalo Street
Democrat
(360) 786-7838
Chipalo.Street@leg.wa.gov

Representative Joe Timmons
Democrat
(360) 786-7854
Joe.Timmons@leg.wa.gov

Representative Adam Bernbaum
Democrat
(360) 786-7916
BERNBAUM_AD@leg.wa.gov

Representative Greg Nance
Democrat
(360) 786-7842
Greg.Nance@leg.wa.gov

Representative Victoria Hunt
Democrat
(360) 786-7852
Victoria.Hunt@leg.wa.gov

Representative Lisa Parshley
Democrat
(360) 786-7992
Lisa.Parshley@leg.wa.gov

Representative Natasha Hill
Democrat
(360) 786-7888
Natasha.Hill@leg.wa.gov

Representative Shaun Scott
Democrat
(360) 786-7920
Shaun.Scott@leg.wa.gov

Representative Edwin Obras
Democrat
(360) 786-7834
Edwin.Obras@leg.wa.gov

Representative Osman Salahuddin
Democrat
(360) 786-7936
Osman.Salahuddin@leg.wa.gov

Representative Janice Zahn
Democrat
(360) 786-7894
Janice.Zahn@leg.wa.gov

The following legislators voted nay:

Representative Ed Orcutt
Republican
(360) 786-7990
ed.orcutt@leg.wa.gov

Representative Mike Steele
Republican
(360) 786-7832
mike.steele@leg.wa.gov

Representative Joe Schmick
Republican
(360) 786-7844
joe.schmick@leg.wa.gov

Representative Dan Griffey
Republican
(360) 786-7966
dan.griffey@leg.wa.gov

Representative Drew Stokesbary
Republican
(360) 786-7846
drew.stokesbary@leg.wa.gov

Representative Michelle Caldier
Republican
(360) 786-7802
michelle.caldier@leg.wa.gov

Representative Tom Dent
Republican
(360) 786-7932
tom.dent@leg.wa.gov

Representative Skyler Rude
Republican
(360) 786-7828
skyler.rude@leg.wa.gov

Representative Mary Dye
Republican
(360) 786-7942
mary.dye@leg.wa.gov

Representative Andrew Barkis
Republican
(360) 786-7824
andrew.barkis@leg.wa.gov

Representative Jim Walsh
Republican
(360) 786-7806
jim.walsh@leg.wa.gov

Representative Carolyn Eslick
Republican
(360) 786-7816
carolyn.eslick@leg.wa.gov

Representative Jenny Graham
Republican
(360) 786-7962
jenny.graham@leg.wa.gov

Representative Chris Corry
Republican
(360) 786-7810
chris.corry@leg.wa.gov

Representative Jeremie Dufault
Republican
(360) 786-7874
DUFAULT_JE@leg.wa.gov

Representative Alex Ybarra
Republican
(360) 786-7808
alex.ybarra@leg.wa.gov

Representative Rob Chase
Republican
(360) 786-7984
Rob.Chase@leg.wa.gov

Representative Mark Klicker
Republican
(360) 786-7836
Mark.Klicker@leg.wa.gov

Representative Joel McEntire
Republican
(360) 786-7870
Joel.McEntire@leg.wa.gov

Representative Peter Abbarno
Republican
(360) 786-7896
Peter.Abbarno@leg.wa.gov

Representative Cyndy Jacobsen
Republican
(360) 786-7968
Cyndy.Jacobsen@leg.wa.gov

Representative Stephanie Barnard
Republican
(360) 786-7986
Stephanie.Barnard@leg.wa.gov

Representative April Connors
Republican
(360) 786-7882
April.Connors@leg.wa.gov

Representative Travis Couture
Republican
(360) 786-7902
Travis.Couture@leg.wa.gov

Representative Sam Low
Republican
(360) 786-7967
Sam.Low@leg.wa.gov

Representative Stephanie McClintock
Republican
(360) 786-7850
Stephanie.McClintock@leg.wa.gov

Representative Suzanne Schmidt
Republican
(360) 786-7820
Suzanne.Schmidt@leg.wa.gov

Representative Kevin Waters
Republican
(360) 786-7994
Kevin.Waters@leg.wa.gov

Representative Clyde Shavers
Democrat
(360) 786-7884
Clyde.Shavers@leg.wa.gov

Representative Hunter Abell
Republican
(360) 786-7988
Hunter.Abell@leg.wa.gov

Representative Brian Burnett
Republican
(360) 786-7954
Brian.Burnett@leg.wa.gov

Representative Andrew Engell
Republican
(360) 786-7908
Andrew.Engell@leg.wa.gov

Representative Michael Keaton
Republican
(360) 786-7948
Michael.Keaton@leg.wa.gov

Representative Deb Manjarrez
Republican
(360) 786-7856
Deb.Manjarrez@leg.wa.gov

Representative Matt Marshall
Republican
(360) 786-7912
Matt.Marshall@leg.wa.gov

Representative Joshua Penner
Republican
(360) 786-7866
Joshua.Penner@leg.wa.gov

Representative John Ley
Republican
(360) 786-7812
John.Ley@leg.wa.gov

Representative David Stuebe
Republican
(360) 786-7976
David.Stuebe@leg.wa.gov

The following legislators were excused:

Representative Mike Volz
Republican
(360) 786-7922
mike.volz@leg.wa.gov

Representative Alicia Rule
Democrat
(360) 786-7980
Alicia.Rule@leg.wa.gov

Representative Gloria Mendoza
Republican
(360) 786-7960
Gloria.Mendoza@leg.wa.gov

Legislative Bill Information Website: http://apps.leg.wa.gov/billinfo/

Initiative 960 Website: http://www.ofm.wa.gov/tax/default.asp

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