This bill adds a new section to chapter 74.09 RCW creating a statutory payment program, beginning September 1, 2026, to pay home health agencies for specified "complex care services" when those services are provided to enrollees under 18 in the medical assistance program by a parent, guardian, family member, or similar close relation under certain conditions. The change is a new law establishing payment eligibility and related procedural requirements; it is not presented as an amendment to criminal penalties. Key conditions set by the section: the caregiver must be employed by a home health agency licensed under chapter 70.126 RCW and have a provider agreement with the authority or a managed care organization; the caregiver must complete at least 75 hours of instruction offered by an accredited home care agency and be determined competent; the services must be delegated by a registered nurse licensed under chapter 18.79 RCW. The authority is directed to recognize accrediting organizations whose standards permit home health agencies to train caregivers consistent with specified federal regulations (42 C.F.R. §§ 483.151–483.154 and 484.80). Training is portable if the caregiver changes employers, home health agencies must pay all training costs and may not require caregiver reimbursement, and when determining eligibility the authority may consider only the child's income. The authority must seek a state plan amendment or waiver from the Centers for Medicare & Medicaid Services to implement the section, and must submit a report by September 1, 2029 assessing the program’s viability and effectiveness using available data without compelling agencies to provide additional data. The bill defines "complex care services" as care provided under RN direction by the named caregivers to persons under 18 and gives examples of medical and personal care tasks (including transfers, feeding, catheter and tracheostomy care, medication administration, respiratory care, and other tasks the authority approves). Affected parties include the unspecified "authority," licensed home health agencies, managed care organizations, registered nurses under chapter 18.79 RCW, recognized accrediting organizations, and enrollees under 18 in the medical assistance program. Important implementation details are not specified in the extracted text: the bill does not define the "authority," it does not set payment rates or billing mechanics, it does not list which accrediting organizations will be recognized, it does not provide a timeline or specifics for seeking federal approval, and it does not identify the specific data sources or metrics for the required report.

If enacted, Medicaid will allow home health agencies to hire and be paid for having trained parents or close family members provide many skilled in-home nursing tasks for children under 18, starting September 1, 2026. Families could be employed and paid through those agencies and caregivers can move between employers without redoing training; agencies must provide and pay for at least 75 hours of training, secure RN delegation, and maintain provider agreements. Using only the child’s income to determine eligibility may let more multi-earner households qualify. The biggest effects will be on families of medically complex children, home health agencies, and registered nurses: families may gain paid employment and more continuity of care, agencies gain a new revenue source but also new training and employment costs and supervision responsibilities, and RNs must oversee delegated tasks. Implementation hinges on federal approval (a state plan amendment or waiver), payment amounts and billing rules are not specified in the available facts, and the entity called the “authority” is not defined here, leaving key operational and timing details uncertain; a program viability report is required by September 1, 2029.