WA budget includes $150M to maintain health coverage for low-income immigrants

Thousands of people who are not U.S. citizens would continue to receive Medicaid-like health care coverage in Washington state under the budget plan the Legislature recently approved.

But the program could make the state a target for Medicaid cuts Republicans in Congress are pursuing.

Washington opened its Apple Health Expansion program for immigrants without legal status last year. Enrollment remains capped based on available funding, which is set to be maintained at roughly $150 million in the next two-year budget. The budget bill is awaiting a signature from Gov. Bob Ferguson.

This week, Republicans in the U.S. House pushed ahead with legislation that would penalize states that have these kinds of health care programs for immigrants.

The federal government pays 90% of the cost of covering enrollees who qualify for Medicaid under expanded income eligibility guidelines in the 2010 Affordable Care Act. That match would decrease to 80% if states choose to keep covering immigrants with programs like Washington's.

In total, Washington state received around $20 billion in Medicaid funding from the federal government during the 2023 federal fiscal year, according to KFF, a nonpartisan health research organization. KFF data also show that, as of 2021, about 821,000 people were covered under the Affordable Care Act expansion where Republicans are looking to reduce the federal match.

Washington's Health Care Authority, which oversees the state's Medicaid program, said they are closely monitoring federal discussions about potential changes to Medicaid funding. But it wasn't immediately clear what the possible cut could mean for the state in dollar terms.

Local advocates have praised the Apple Health Expansion program for immigrants, saying it extends a critical safety net to a community that has been excluded.

"Immigrants came forward this session with the full knowledge that doing so could mean deportation — or worse," Catalina Velasquez, executive director of the Washington Immigrant Solidarity Network, said in a statement.

"These victories are the result of decades of movement-building, sacrifice, and visionary struggle to ensure all immigrants have the resources needed to thrive," she added.

Federal law prohibits noncitizens from accessing public benefits such as Medicaid, but states can use state dollars to create programs for this community.

About 1.8 million residents in Washington were covered by Medicaid or the related Children's Health Insurance Program in December, according to U.S. Centers for Medicare & Medicaid Services figures. Washington's Medicaid program is called Apple Health.

The Apple Health Expansion program for immigrants designed to mirror Medicaid and is funded solely by the state, whereas the traditional Medicaid program is funded with both federal and state dollars.

The expansion launched on July 1, 2024 with enough funding to cover up to 13,000 people. Within the first 48 hours, all slots were filled, and an additional 17,000 people signed up for the waiting list.

Washington state Republicans have criticized the program and argue the state needs to be more careful with its spending, especially given a multi-billion dollar budget shortfall lawmakers just worked to solve. They've also said that the state shouldn't be maintaining services for noncitizens while cutting services for others.