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Aug. 4—Federal changes in Medicaid will have an effect on Yakima Valley patients, health care providers and hospitals, speakers at a community forum said last week.

President Trump's "One Big, Beautiful Bill" will bring changes in eligibility and work requirements. The state expects at least 250,000 Washingtonians will lose Medicaid coverage and 150,000 will be priced out of the state's health care exchange, according to the governor's office.

Between the Ridges sponsored a Medicaid forum at the Henry Beauchamp Community Center Wednesday. It featured a panel of 10 local nurses, health care providers and advocates who spoke to a crowd of about 50 people. Between the Ridges is a local nonprofit organization that aims to build community.

Medicaid, known as Apple Health in Washington state, is a government health insurance program for people making 138% or less of the federal poverty level. It's different than Medicare, which is a federal health insurance program for people with a disability or who are 65 and older.

It covers hospital services, home health services, mental health services, prescriptions and more.

In 2023, more than 130,000 Yakima County residents, 50% of the county's population, were enrolled in Apple Health. Nearly 87% of people younger than 19 in Yakima County use Apple Health.

MultiCare Yakima Memorial Hospital gets 25% of its gross revenue from Medicaid, with Astria Toppenish getting 36.9% and Astria Sunnyside getting 32.2%, according to the state Department of Health.

Barriers to access

Christy Trotter, CEO of the Yakima Valley Farm Workers Clinic, discussed who will be impacted by the One Big, Beautiful Bill's proposed Medicaid eligibility requirements.

The six-month renewal cycle and the community engagement requirements will affect Medicaid recipients covered through the Affordable Care Act expansion that went into effect in 2014, she said.

Individuals eligible for Medicaid through the Medicaid expansion will need to engage in community service, work, education, or other activities to qualify, the bill states. The work requirements are required to go into effect in January 2027, though states can implement them earlier.

States cannot waive the requirements but can choose to provide exceptions for those experiencing short-term hardships, such as hospitalization.

People with serious medical conditions or those with dependent children ages 13 or younger are excluded from the requirements, among others.

"Once this gets implemented, we'll have a clear vision about what's going to be involved in staying eligible," Trotter said.

Jordann Loehr, an OB/GYN in Yakima County, said she already sees a large portion of uninsured or under-insured patients at her clinic.

"When people come who don't have Medicaid or cash, they come later," Loehr said. "So they're more likely to be diagnosed with (diseases) that are more expensive to treat than if they had come unafraid of the costs of services."

Homelessness

The 80-hour monthly minimum work, community service and work program requirements, or education requirement, could affect people experiencing homelessness in Washington on Medicaid, or those who qualify.

Panelist Kyle Curtis, Yakima's district 2 county commissioner, spoke about the county plans to tackle homelessness.

Curtis and others have spent the past year-and-a-half updating the county's five-year-plan to address homelessness, he said.

"I look forward to, in my capacity, being able to help mitigate where the county can and participate, where the county can, with any state initiatives," Curtis continued.

In response to a speaker talking about the importance of Medicaid, Curtis noted the need to pay attention to the people behind the numbers.

"A lot of the time when we have this conversation about the cuts, we want to look at numbers," he said. "We forget the human element and that's where the conversation should be."

Planned Parenthood and women's health

For low-income women, seeking reproductive or preventative care could be more difficult under the One Big Beautiful Bill.

The bill prohibits Medicaid payments to nonprofit organizations that serve predominantly low-income or medically undeserved individuals for one year if the provider primarily furnishes family planning services, reproductive health, and related care; offers abortions in cases other than rape, incest, or life-threatening conditions; and received federal and state Medicaid payments totaling more than $800,000 in fiscal year 2023.

While Planned Parenthood isn't specifically named, the organization said the provision targets their centers nationwide.

"I'm concerned that does put us in a position where we're at risk of closing our centers," said Charlie Lopez Salgado, Yakima-based organizer for Planned Parenthood.

A federal judge blocked the provision last week.

Gov. Bob Ferguson said Washington state will cover the gap caused by the one-year moratorium on Planned Parenthood funding.

"In Washington, Planned Parenthood receives at least $22 million a year in Medicaid funding, which includes at least $11 million from the federal government," he said in a news release. "It is one of Washington's preeminent Medicaid providers."

Planned Parenthood provides services including preventative care and cancer screenings. Medicaid funding cannot be used for abortion services.

Hospitals at risk

Hospitals that already operate on small profit margins, especially in rural areas, are going to face more costs when the One Big Beautiful Bill's propositions lower Medicaid reimbursement rates, said Jacob Garcia, registered nurse at Astria Sunnyside Hospital.

In the wake of the bill's passage, officials at Astria Health expressed concern about the future of Astria Toppenish hospital. The Toppenish hospital closed its maternity center in late 2021, citing financial losses, fewer deliveries and reduced Medicaid funding.

U.S. Rep. Dan Newhouse, who represents Central Washington in Congress, introduced legislation in July to make the Toppenish hospital a critical access hospital, which would provide additional financial help. He said he is committed to keeping rural hospitals open.

Trump's bill sets up a $50 billion rural health fund, which isn't enough to cover the estimated loss of Medicaid funding in rural areas, according to KFF, which provides health policy research and news.

Information from state Republicans said Washington stands to gain $100 million to $200 million annually that could be directed toward stabilizing the rural hospital workforce, operations, innovation and care expansion.

Speakers at the forum urged attendees to register to vote, stay involved and informed, and contact their local elected officials to voice their concerns.

Any tips should be sent directly to Alexander Banks through email at abanks@yakimaherald.com, or by phone at 509-577-7654.

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