Creates a new "essential worker health care program" by adding new sections to chapters 43.20A and 48.02 RCW. The department of social and health services (DSHS) would establish and administer the program, disbursing annual supplemental Medicaid-related payments to participating nursing home employers (subject to appropriations and any required CMS approvals). Participation requires an employer memorandum of understanding, documentation of the two prior years of employee health care spending, and commitments to maintain spending levels and report enrollment and cost data annually. The office of the insurance commissioner (OIC) must annually certify participating "qualified health funds" (including certain MEWAs, association plans, and Taft‑Hartley funds) that meet benefit and participation standards; OIC may enforce or revoke certifications and must notify DSHS if it takes or contemplates such action. The bill creates a funding and oversight procedure: DSHS distributes supplemental payments proportionally by prior-year Medicaid bed days, may recoup payments from employers or funds that lose certification or are terminated for noncompliance, and must administer a recoupment process that includes audits at least every two years, written notice with a 30‑day appeal opportunity, and recovery mechanisms (text cuts off before fully describing all recovery methods). DSHS must report all recoupment activities to the Legislature annually, including amounts recovered and the basis for recoupment. The measure sets specific certification and program rules: qualified funds must include at least two unrelated employers; non‑Taft‑Hartley association or MEWA funds must have offered—or initially demonstrate anticipated enrollment of—at least 5,000 long‑term care industry employees in Washington; benefit packages must be actuarially equivalent to an ACA platinum plan (Taft‑Hartley plans may follow trust board approval); Taft‑Hartley funds with boards that are at least 50 percent union‑represented may use union certification to meet certain spending‑maintenance requirements. Implementation of the program is explicitly contingent on CMS approval of a state plan amendment or waiver, and the department must submit that application no later than six months after state funds are appropriated for the program. Some text is incomplete or missing from the provided extracts: the recoupment recovery mechanisms are cut off mid‑sentence, section 6 and some referenced provisions are not fully included, and a few places generically refer to "the department" without naming it (although DSHS is named elsewhere as the administering and disbursing agency).

If enacted and approved by CMS, the state would provide annual supplemental payments to Medicaid-participating nursing homes based on each facility's prior-year Medicaid bed days to help fund higher-quality, affordable health coverage for nursing home workers, but only when employers sign a participation agreement and channel benefits through an OIC‑certified "qualified health fund" that meets benefit, participation, and reporting rules. Employers must document prior health spending, keep their per-employee spending at least at the two‑year average (with future increases tied to the health insurance CPI), regularly report enrollment and cost data, and face audits and potential recoupment if a fund loses certification or they fail to comply. The most affected parties are Medicaid-participating nursing home operators (who would receive new, conditional revenue but take on compliance, reporting, administrative costs, and repayment risk), nursing home workers (who are likely to get more comprehensive plans if employers comply), qualified health funds (which must meet annual certification, enrollment, and benefit standards and may be subject to OIC enforcement), and state agencies (DSHS must apply to CMS, administer payments, audit and recover funds and report recoupments to the legislature; OIC must certify and oversee funds). Implementation timing and some recoupment details are unclear in the provided text because the program is contingent on CMS approval and portions of the recoupment mechanism are not fully included here.