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The Health Care Authority (HCA) legislative priorities are now live on our website. Visit HCA's Legislative Priorities page to learn more about what we will work towards during the 2027 legislative session, including our agency request legislation and our decision packages.
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How we chose what to prioritize
HCA faces unique challenges driven by both federal and state pressures. Federal changes—like the passage of H.R. 1 in July 2025, along with required and shifting federal directives—impact every pillar of HCA’s work. These changes will generate significant work in the years to come, requiring staffing and technology resources to ensure that:
- As many Washingtonians as possible can keep their health care coverage.
- We are in compliance with federal regulations to avoid any fiscal consequences.
At the same time, many in Washington still struggle to access quality and affordable health care, which is further compounded by the state’s current fiscal realities. Increasing state costs, federal funding cuts, population growth, and ongoing economic uncertainty all contribute to anticipated budget shortfalls during the 2027–2029 biennium.
HCA’s 2027 agency request legislation and decision packages seek to meet these challenges through building on the significant investments our state has made in the health care delivery system over the past decade. HCA seeks to keep the state well-positioned to drive better health outcomes and control costs.
2027 agency request legislation
Our agency request legislation this year includes:
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Third-party liability enforcement – Provides HCA with rulemaking authority to enforce existing requirements of health insurers to provide third-party eligibility information to the agency, in alignment with federal Medicaid coordination of benefit requirements.
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Substance use disorder (SUD) patient rights – Allows HCA to enforce prohibitions on discrimination by providers and treatment facilities against patients who are on or in need of medications for treating substance use disorder, driven by annual complaints about facilities inappropriately restricting access to medications for opioid use disorder (MOUD).
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Healthy Youth Survey – Amends the Public Records Act (RCW 42.56.320) to exempt student survey responses to the Healthy Youth Survey from public disclosure to protect against the potential re-identification of survey respondents.
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Public option – Strengthens Washington’s public option program (Cascade Select), including adjusting the reference pricing structure, broadening hospital participation requirements, and connecting Cascade Care Savings (state subsidies) to public option enrollment, with the goal of increasing provider access and the affordability of plan offerings for Health Benefit Exchange customers.
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