The bill aims to implement recommendations from the state auditor to reduce improper Medicaid concurrent enrollment payments by enhancing collaboration between the authority and the department. It introduces several new sections to chapter 74.09 RCW, which include provisions for notifying the authority when individuals enrolled in both Medicaid and other income-based programs move out of state. The authority is tasked with working alongside federal agencies to clarify eligibility criteria for Medicaid based on residency and to ensure that caseworkers are trained to prevent concurrent enrollments. Additionally, the bill 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. It also requires annual reporting on the recovery of premiums and the identification of individuals with concurrent enrollments. The state auditor is tasked with conducting a performance audit by December 31, 2031, to evaluate the financial impact of concurrent Medicaid coverage. Additionally, the bill amends RCW 74.09.035 to ensure that notices regarding program eligibility are clear and meet established plain language guidelines, and that all correspondence includes "address service requested."

Statutes affected:
Original Bill: 74.09.035
Substitute Bill: 74.09.035