The bill aims to implement recommendations from the state auditor to reduce improper Medicaid concurrent enrollment payments in Washington. It introduces several new sections to chapter 74.09 RCW, which require collaboration between the authority and the department to notify each other when individuals enrolled in both Medicaid and other income-based programs move out of state. Additionally, the authority is tasked with working alongside federal agencies to clarify eligibility determinations for clients receiving social security income and to ensure that caseworkers are trained to prevent concurrent enrollments in multiple Medicaid programs. The bill also mandates that managed care organizations analyze their enrollment records monthly to identify individuals enrolled in multiple state Medicaid programs and report these findings to the authority.

Furthermore, the bill outlines specific actions to be taken starting January 1, 2026, including amending contracts with managed care organizations to allow the state to recover premiums for enrollees who have moved out of Washington and have not received services. An annual report detailing the premiums recovered and the number of individuals identified as concurrently enrolled will be submitted to the governor and relevant legislative committees. By December 31, 2031, the state auditor is required to conduct a performance audit on concurrent Medicaid enrollments to assess costs and progress in limiting unnecessary premiums. The bill also amends existing law to ensure that notices regarding program eligibility are clear and meet established plain language guidelines.

Statutes affected:
Original Bill: 74.09.035
Substitute Bill: 74.09.035