Long-term care money for WA immigrants to cover fewer people

Officials had hoped the money would stretch further. Refugees, asylees and other lawfully present noncitizens are losing Medicaid coverage Oct. 1.

Washington state lawmakers this year approved spending nearly $20 million to ensure immigrants here could retain long-term care insurance coverage they're set to lose under federal law.

Legislators and advocates thought that money would put the state on a path to cover nearly 1,200 lawfully present noncitizens.

It turns out that it'll only be enough for 173.

That's according to Adam Glickman, secretary-treasurer for Service Employees International Union 775, the caregivers' union, which pushed hard for the funding.

The revelation, based on changing assumptions from federal guidance, was "disappointing and frustrating," Glickman said.

"It puts individuals and families in really difficult situations, and really, in some cases, dangerous and unhealthy situations," he said.

The original goal of wider coverage would cost tens of millions more dollars each year.

Lawmakers assumed the $20 million would cover about 300 people in the current fiscal year, which ends June 30, 2027, before ramping up to the full, nearly 1,200, with closer to $100 million per year in the next two-year budget starting in July 2027, said Rep. Nicole Macri, D-Seattle. But the money this year still doesn't even stretch that far.

Department of Social and Health Services Secretary Angela Ramirez said last week her agency would "continue to look under every rock to see what we can do."

"But make no mistake: When this cut hits, it's going to be harmful," Ramirez said at a roundtable on the issue in Seattle.

The "big, beautiful bill" congressional Republicans passed last year cuts Medicaid coverage for most noncitizens. State officials project nearly 14,000 in Washington will lose coverage on the insurance program for low-income residents starting Oct. 1.

That includes around 1,500 noncitizens receiving long-term care services. Notices of the change went out to these enrollees last month. They'll get termination notices in late August.

The federal law cuts Medicaid coverage for refugees and asylees and other lawfully present immigrants, including people who fled the war in Ukraine, for example. It maintains eligibility for lawful permanent residents and other select categories of migrants.

This will leave immigrants with disabilities without caretaking help with basic tasks, like getting out of bed, taking medication and bathing.

"The reality is people will get sicker," Glickman said.

"Their care goes away, but their needs don't go away, and if anything, they're going to get worse, and so those costs will show up in emergency rooms, in 911 calls, in other crisis situations," he added. "The cost just gets shifted to some other part of the system."

It also means lost income for home care workers. This could force family members who have been caring for their relatives, and getting paid for that work with Medicaid dollars, to get a job outside the home and leave their ailing loved one to fend for themselves more.

What accounts for this?

Part of the problem behind the miscalculation of how many would get to keep their long-term care was that people are getting kicked off Medicaid sooner than expected.

Federal officials decided all members of this population would lose their coverage Oct. 1, not when their annual eligibility determinations came up later on a rolling basis. The federal Centers for Medicare and Medicaid Services informed states of this in the spring, just weeks after the legislative session ended and the state budget was passed.

The feds also ruled that, contrary to prior rules, people who receive Supplemental Security Income, or SSI, would not automatically be eligible for Medicaid as they have been. Macri called this decision "unprecedented."

State officials also underestimated the costs of medical services for the long-term care population, resulting in funding not robust enough for their acute needs, Macri said.

Of the 1,500 or so people affected, the vast majority receive home-care services, while about 100 are in facilities like adult family and skilled nursing homes. The state is prioritizing those in facilities to retain coverage while almost all in home settings could lose Medicaid, Macri said.

"How do you prioritize who gets a little amount of resources is always tricky to figure out," she said.

What can be done?

SEIU 775 leaders have been meeting with state officials and lawmakers, urging them to find more money before the legislative session begins in January to ensure these people keep their coverage. But Washington faces fiscal troubles limiting new spending.

"Getting the entire thing seems pretty challenging, given this budget situation," Glickman said. "We are pushing for them to do as much as they can."

Macri has called on Gov. Bob Ferguson's office and agency leaders to be creative to maintain at least some care. She's asked if a reduced Medicaid benefit was feasible to make the state dollars stretch further, but agency officials told her that wasn't possible to implement given the Oct. 1 deadline. She's also inquired if the state has money available that could be shifted in the near-term to cover the costs.

Ramirez suggested the state could reach out to enrollees to see if they can adjust their immigration status, or find other paths to maintain coverage. Officials have already found 1,500 people who can keep their long-term care services because their status had changed, but hadn't notified the state, according to the Department of Social and Health Services.

The work requirements that'll likely force tens of thousands more off Medicaid take effect in January. The separate elimination of federal subsidies for Affordable Care Act health care through the state's exchange has already resulted in upward of 36,000 enrollees forgoing insurance.

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