This bill creates a new "essential worker health care program" placed within the department (identified elsewhere as the Department of Social and Health Services in the extracted text) to provide nursing home workers with high-quality, affordable health coverage through participating nursing home employers. It adds new sections to chapter 43.20A RCW and chapter 48.02 RCW, requires employers to enter memoranda of understanding to receive annual supplemental payments distributed pro rata based on each employer’s Medicaid bed days, and conditions program implementation on Centers for Medicare and Medicaid Services (CMS) approval of a state plan amendment or waiver that provides federal financial participation. The department must submit the CMS application by July 1, 2025, establish the program by July 1, 2026, and report to the legislature by December 1, 2025. The Office of the Insurance Commissioner (OIC) must annually certify "qualified health funds" that meet specified criteria (including employer participation structure, minimum enrollment or anticipated enrollment thresholds for fully insured plans, benefit standards comparable to an ACA platinum plan or trust-board approval for Taft-Hartley trusts, and employee input requirements except for Taft-Hartley plans). The OIC may enforce certification standards, revoke certification, and must notify DSHS of enforcement actions. Employers must maintain prior-year spending levels on employee health care (with a CPI adjustment in later years), allocate substantially all program funds to a certified fund, provide documentation and annual demonstrations that supplemental payments significantly improved benefit quality, and meet other department rule requirements. The bill creates a recoupment and compliance procedure rather than new criminal penalties: the department must audit participating employers at least once every two years, provide written notice and a 30-day appeal for noncompliance findings, and recover funds by offsetting future payments, direct reimbursement, or other means set by rule; the department must report recoupment activity annually to the legislature. Any supplemental payments made before CMS approval are contingent on retroactive federal matching fund approval or are subject to the recoupment process. Section 6 of the act is declared immediately effective under an emergency clause. Some text is missing or unclear in the extracted material: the chunk ends mid-sentence in one section, the initial statutory reference for "the department" is not present here, the full content of Section 6 is not included, and the authority or timing for identifying state funding alternatives is not specified in the provided excerpts.

If enacted, the state would set up a program run by DSHS that routes annual supplemental Medicaid-based payments to nursing home employers so they can offer employees higher-quality, affordable health coverage through certified multiemployer or Taft‑Hartley-type plans. Nursing home employers who want the money must sign an MOU, meet spending and reporting rules (including maintaining recent levels of health‑benefit spending), and use the funds almost entirely through an OIC‑certified qualified health fund; those funds must meet enrollment and benefit standards and can be decertified by the insurance commissioner. The practical effects are that Medicaid‑participating nursing home operators, the multiemployer/union funds that insure their workers, and covered nursing home staff are most affected: employers will have new administrative and spending obligations, potential costs if they must increase benefits or document past spending, and a real risk of audits and recoupment if they fail to comply; insurers and Taft‑Hartley trusts will face certification requirements and oversight. Federal approval by CMS is required for the payments to get federal matching dollars (the state must apply by July 1, 2025 and establish the program by July 1, 2026), payments made before CMS approval would need retroactive federal match or could be recovered, and the text leaves some implementation details and the exact contents of the immediately effective Section 6 unclear.