This bill creates a new "medicaid access program" administered by the Washington State Health Care Authority that levies annual covered-lives assessments on health carriers and Medicaid managed care organizations to finance specified increases in Medicaid professional service rates. The authority must submit required state plan amendments or waiver requests to CMS by September 1, 2025, and assessment collection and disbursement are conditioned on CMS approval, any needed amendments to authority–MCO contracts, and Office of Financial Management certification that appropriations fully support the rate increases. The act establishes initial per-member-per-month assessment amounts ($18 PMPM for Medicaid MCOs and $0.50 PMPM for health carriers for the first plan year), requires the authority to set assessment rates annually (on or before May 15), fixes the MCO-to-carrier assessment ratio at 36:1, caps assessments to the first 3,000,000 member months per entity, sets payment timing and interest for late payments, allows abatements or deferrals in limited circumstances, and creates a medicaid access program account in the state treasury to receive assessment receipts and to fund payments and the nonfederal share of increased capitation. The bill directs that, beginning January 1 of the second plan year after the statutory conditions are met, Medicaid professional service rates (fee-for-service and managed care) may be increased up to the corresponding Medicare rates as of December 31, 2024, for the same service and site of service, with subsequent annual adjustments tied to the Medicare Economic Index; if funds are insufficient, the authority may apply a uniform percentage of Medicare rates across listed service categories. It preserves the federal requirement that rates paid to MCOs be actuarially sound under 42 C.F.R. §438.4. The authority and the insurance commissioner are authorized to adopt rules and take actions to implement assessments, enforce reporting and audits of covered lives, and manage plan operations; the act also provides specified civil and criminal immunity for good-faith actions or inactions by the program, assessed entities, the authority, and commissioner personnel, while preserving legal actions to enforce statutory or contractual duties. The bill reenacts and amends RCW 43.84.092 to establish or modify the "treasury income account" for earnings on investments of surplus treasury balances, sets monthly distribution rules and priority payments (including refunds required under the federal Cash Management Improvement Act and payments for purchased banking services), authorizes OFM to determine CMIA amounts and direct transfers, and lists numerous accounts and funds that receive proportional earnings based on average daily balances. The act creates new chapters in Titles 74 and 48 RCW, declares nonseverability of its provisions, takes effect immediately, and includes conditional expirations (the act expires if CMS final approval is not obtained by January 1, 2027; section 12 expires July 1, 2028; section 13 takes effect July 1, 2028). Some text is missing from the provided extracts (for example the end of section 7, section 15, and the full text of the reenacted/amended RCW 43.84.092), so specific language in those sections and any additional implementation details or definitions contained elsewhere in the bill are not available here.

If enacted, Washington would impose annual per-member assessments on Medicaid managed care organizations and fully insured health carriers (initially set at $18 PMPM for MCOs and $0.50 PMPM for carriers, with collections required up to the first 3,000,000 member months per entity and a required 36:1 split between MCO and carrier collections) to create a dedicated medicaid access program fund that can be used to raise Medicaid professional service rates — potentially up to Medicare rates as of December 31, 2024 — starting January 1 of the second plan year after the Health Care Authority submits and obtains CMS approval of required state plan amendments or waivers (to be submitted by September 1, 2025) and after OFM certifies appropriations. Payments would be due on a 45-day schedule with interest after day 46, the authority can set payment rates annually and may abate or defer assessments for financially distressed MCOs (with deferred liability accruing interest), and the money would flow into a new medicaid access program account in the treasury subject to monthly earnings distribution rules and CMIA-related procedures described in the bill. The direct winners and losers are clear: Medicaid providers would likely receive higher professional service payments if sufficient assessments and approvals occur, while MCOs and fully insured carriers face new, measurable assessment costs and reporting and payment responsibilities (plus potential audit and rule compliance), and the Health Care Authority, Insurance Commissioner, OFM, and State Treasurer take on new administrative duties and rulemaking authority but receive statutory immunity for good-faith actions; key implementation details and some sections referenced in the bill are missing from the provided text, and the program is conditional—if CMS does not approve the federal changes by January 1, 2027 the act expires, and the bill is nonseverable so failure of parts could affect the whole.