This bill adds several new sections to chapter 74.09 RCW and amends RCW 74.09.035 to create new procedural requirements for identifying and handling Medicaid enrollees who move out of state. It directs an unnamed "authority" and "department" to coordinate with the Social Security Administration and CMS to clarify when Social Security income recipients lose state Medicaid eligibility due to out-of-state residency, to develop implementing rules, and to use the USPS National Change of Address database on an annual rolling basis to identify out-of-state moves. If SSA and CMS do not provide guidance, the state auditor must make recommendations. The bill requires contract and process changes with managed care organizations beginning January 1, 2026, including recovery of premiums when an enrollee has moved out of Washington and did not receive services in the managed care area, monthly analysis by multi-state MCOs to detect the same person enrolled in more than one state Medicaid program and monthly reporting of those results to the authority and affected states. It creates reporting and audit requirements: an annual authority report to the governor and legislative committees for five years starting January 1, 2027, and a state auditor performance audit of concurrent Medicaid enrollments in Washington by December 31, 2031. The amendment to RCW 74.09.035 limits and specifies procedures for providing medical care services to certain groups (including victims of human trafficking, persons eligible for aged/blind/disabled assistance, and those eligible for essential needs and housing support) to the extent of available funds, allows enrollment freezes and waiting lists if appropriations would be exceeded, and requires plain language notices and specific mailing instructions. This bill primarily creates procedural changes, reporting obligations, contract requirements, and statutory modifications; it does not specify new criminal penalties. The text uses the terms "the authority" and "the department" and cites other statutes, but those entities and some implementation details are not defined or included in the provided text.

If enacted, managed care organizations that operate in multiple states will have to run monthly checks to find people enrolled in more than one state’s Medicaid program, report those matches to the state authority, and change contracts so the state can recover premiums for enrollees who moved out of Washington and have not used services. The state authority and the (unnamed) department will also run an annual address match against the USPS change-of-address file, work with SSA and CMS on rules about out-of-state residency, produce yearly reports starting in 2027, and face a state auditor performance audit by 2031. Expect added administrative and reporting costs for MCOs and state agencies, some recovered premiums that could lower state Medicaid outlays, and more frequent identification of enrollees who may be disenrolled or whose coverage is adjusted when an out-of-state move is found. The bill also caps how much medical care these newly defined groups (victims of human trafficking, people qualifying as aged/blind/disabled, and those eligible for essential needs and housing support) can receive to the amount of money appropriated, allowing the department to freeze new enrollments and create waiting lists if funds run out; written notices must be mailed with “address service requested,” which raises mailing costs. It’s unclear from the provided text which specific state entities “the authority” and “the department” refer to, how the new checks and premium recoveries will be funded or enforced, and what precise procedures will be used to change enrollment or recover funds.