DSHS to help transform Medicaid in Washington

The Health Care Authority (HCA) signed an agreement with the Centers for Medicare and Medicaid Services (CMS) for a five-year Medicaid transformation demonstration waiver. This will provide up to $1.1 billion in incentives to achieve better health, better care, and better value; as well as $375 million to support services for individuals who need long-term services and supports (LTSS), supportive housing or supported employment.

Following the announcement in October of an agreement in principle, the state and CMS entered into negotiation of the terms and conditions that further describe how Medicaid will be transformed through three initiatives:

1. Delivery system transformation strategies led by regional Accountable Communities of Health;
2. A broader array of service options to enable older adults and individuals with disabilities to stay at home and delay or avoid the need for more intensive care;
3. Key Foundational Community Support Services for Medicaid clients with the most critical needs.

“Improving the health of our children and their families through better medical, mental and substance use treatment is fundamental to improving the economic and social well-being of our citizens,” Acting DSHS Secretary Pat Lashway said. “This demonstration project will provide support to all areas of the state to improve the effectiveness of care and enable mental health services to reach all of our communities. And it helps us address the rapid growth in the aging population by providing innovative ways of delivering long-term care services."

Washington has been a national leader in providing LTSS that help people remain in their homes and communities. Our LTSS system has sustained the ranking of 2nd in the nation by AARP for its high performance while at the same time ranking 34th in cost.  These efforts have saved billions of dollars over the past two decades.  However, our population is aging, increasing the number of individuals who will be in need of these services. The flexibility of this waiver will make it possible for us to offer innovative new services that will:

The flexibility of this waiver will make it possible for us to offer new services to Medicaid beneficiaries that will:

• Preserve and promote choice in how individuals and families receive services;
• Support families in caring for loved ones while increasing the well-being of the caregiver;
• Delay or avoid the need for more intensive Medicaid-funded long-term services and supports where possible;
• Address the social determinants of health through housing and employment supports for a targeted population.

For more information on the demonstration, please visit the Medicaid Transformation web page.