Gov. Bob Ferguson of Washington signed an executive order to help mitigate impacts in the state from H.R. 1, federal legislation that cut more than $1.3 trillion in health care and food assistance nationwide. The state has already spent nearly $100 million to implement the federal law and faces an estimated $3.2 billion in costs per biennium if it were to pay for everything the law eliminates.
Two major impacts are coming in the next several months. Starting Oct. 1, H.R. 1 drastically limits Medicaid eligibility for lawfully present immigrants. Before the state took action, 14,000 lawful immigrants were set to lose their Apple Health coverage. Starting Jan. 1, more than 600,000 Washingtonians will be subject to work requirements for the first time in order to keep their Apple Health coverage, and will be required to reapply twice as frequently.
Washington has already achieved two major outcomes through state action. The state has preserved Apple Health coverage for 3,000 Washington immigrants, reducing the projected losses from 14,000 to 11,000. The state is also building an automated verification hub designed to help 400,000 Washingtonians keep their Apple Health coverage by automatically confirming eligibility, allowing people to avoid submitting new paperwork every six months.
Ferguson's executive order establishes the H.R. 1 Continuous Medicaid Response Committee, led by Washington's health services agencies in consultation with the Office of the Insurance Commissioner, Health Benefit Exchange and other agencies. The committee will monitor impacts on Washingtonians and the healthcare system, coordinate responses to future changes, develop a proposal to create a Healthcare Access and Affordability Council to develop strategies to help people keep coverage, and identify barriers and coverage disruptions.
The order directs a coordinated statewide public awareness campaign and requires the Department of Health to develop a data accountability system to track who is losing coverage and where there are gaps. Despite these efforts, at least 200,000 Washingtonians are projected to lose their Apple Health coverage by the end of 2027 as a direct result of H.R. 1.