This bill reenacts and amends RCW 74.09.520. It restates what "medical assistance" may include by enumerating many specific services (hospital, lab/X-ray, nursing facility, physician services, home health, personal care, hospice, therapies, prescription drugs, dental and prosthetic items, and other diagnostic/preventive/rehabilitative services for children consistent with the chapter). It also specifies that routine foot care and non-Title XIX-mandated dental services are not included unless specifically appropriated. The bill makes multiple coverage and procedural changes: it directs the department to adopt rules to align Title XIX personal care services with federal requirements (including financial eligibility indexed to the Social Security Act and medical-condition-based assessments); requires the department to design and implement a functional disability assessment to determine personal care service levels and prioritize those with greatest need; requires contracting with area agencies on aging or federally recognized tribes for case management and reassessment of some in-home clients (with competitive bidding or direct provision allowed if such contractors are unwilling or unable); authorizes, subject to appropriation, Medicare Part D copayment coverage for full-benefit dual eligibles; requires universal autism/developmental delay screening payments effective 1/1/2016 and provider payment for certain youth and maternal depression screenings effective 1/1/2018 (all subject to available funds); requires, subject to appropriation, specified reimbursement allowances for mental health assessment/diagnosis of children birth through five using the DC:0-5 system; requires coverage for USPSTF A or B noninvasive preventive colorectal screening tests and resulting colonoscopies effective 1/1/2024; addresses hospital payment for days when a medical assistance enrollee does not meet acute inpatient criteria or cannot be discharged for lack of placement and directs related rulemaking on payment, billing separations, and managed care processes; and, beginning 1/1/2027, requires coverage for medically necessary massage therapy by a licensed massage therapist as a nonpharmacological pain treatment when referred by an authorized provider. Many provisions are expressly subject to available appropriations and further rulemaking. The text refers to "the authority" and "the department" without naming their formal agency titles, and it relies on other RCWs for definitions and scope. Specific rule content, payment rates, billing codes, and precise definitions for terms such as "licensed massage therapist" and "provider authorized to order or refer items or services" are not included in these extracts and would be determined by later rulemaking or by examining the cited statutes.

If enacted, Washington’s Medicaid program would likely expand which preventive services and treatments are paid for and change how long-term and personal care services are allocated. Expect broader coverage for autism screening, youth and maternal depression screening, preventive colorectal testing, and, starting in 2027, medically necessary massage therapy when prescribed; hospice must be offered and extra reimbursement rules for early childhood mental health assessments are added. The agency running Medicaid would also have to create functional disability assessments to prioritize personal care services based on need, set new hospital payment rules when patients can’t be discharged for lack of placement, and arrange or competitively reassign case management contracts to area agencies on aging or federally recognized tribes if those entities cannot or will not perform the work. The practical effects fall mainly on the state Medicaid agency (more rulemaking, assessments, contracting and payment administration) and on providers (hospitals, managed care plans, area agencies on aging, tribes, early childhood mental health clinicians, and licensed massage therapists) who may gain or change revenue streams and responsibilities. Counties and long-term care providers may see impacts from new discharge/payment rules and prioritization of personal care funds. Many of these expansions are explicitly subject to legislative appropriations or later rulemaking, so the exact scope, timing and fiscal costs remain uncertain until funding and detailed rules are set.