Correction: 2025-27 managed care rate reductions

Washington State Health Care Authority sent this bulletin at 07/29/2025 08:00 AM PDT

July 28, 2025

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2025-27 managed care rate reductions

The fact sheet linked in this bulletin has been updated to correctly identify behavioral health screening rate reductions previously referred to as developmental screening rate reductions.

The 2025-27 Operating Budget directed the Health Care Authority (HCA) to reduce Apple Health (Medicaid) managed care organization (MCO) rates by 1 percent, or approximately $90 million, for calendar year 2026.

Since passage of the budget, HCA has been working with contracted actuaries to analyze the options available to achieve the 1 percent reduction target. The options are constrained by a few factors, including:

Requirements to maintain existing rates for certain services.
Limitations on the extent of MCO administrative funding adjustments.
Limited time to implement.
Avoiding actions requiring CMS approval.

Several specific reductions combined will result in $90 million in reduced expenditures in 2026, including:

Applied behavior analysis (ABA)
Behavioral health screening
Kidney dialysis
Low-level mental health (services provided outside behavioral health agencies)
Urine drug tests

Find more detailed information in the FAQ.

Read the FAQ

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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Nondiscrimination

The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.