This bill creates a new law in Title 74 RCW establishing an "apple health employer assessment" that takes effect beginning the calendar year after the state implements federal Medicaid community engagement requirements (the "community engagement implementation year"). The assessment equals an employer’s total member months in the preceding calendar year multiplied by 100 percent of the Medicaid fair share capitation amount, is calculated annually by the Department of Social and Health Services (DSHS) by March 15, and is collected quarterly—one quarter of the annual assessment remitted each calendar quarter—by the Employment Security Department (ESD) in a form consistent with premium collections under chapter 50A.10 RCW. Collected moneys are deposited into the state health care affordability account and may be spent only after appropriation. The bill creates a new assessment obligation and associated procedures (a new fiscal and administrative requirement), defines key terms, and sets out exclusions. An "apple health employer" is an employer subject to chapter 50A.10 RCW that had one or more "employed" qualified individuals concurrently enrolled in Medicaid in the prior year, with exclusions for employers with fewer than 100 employees in the state, the federal government, the state and state institutions or agencies, and units of local government; for franchises, the franchisor is treated as the apple health employer. "Employed" means a qualified individual who works at least 80 hours per month for the employer. A "qualifying individual" is a person enrolled in Medicaid who meets federal community engagement requirements as determined by the Health Care Authority. The "Medicaid fair share capitation rate" is the composite capitation rate for the Medicaid expansion population using the Health Care Authority’s most recent managed care organization rates as certified by a contracted actuary. Affected agencies named are ESD (collection and notification), DSHS (calculation), and the Health Care Authority (determining the community engagement implementation year, identifying qualifying individuals, and providing capitation rates). The bill requires data-sharing agreements among those administering agencies. Important implementation details are not included here: the text relies on external definitions and procedures in cited statutes (for example chapter 50A.10 RCW, RCW 50A.05.010, and chapter 19.100 RCW), the exact timing of the community engagement implementation year depends on the Health Care Authority’s determination and federal implementation, the methodology for totaling member months beyond the basic definition is not specified, and the process for setting and certifying capitation rates and any appeal or enforcement procedures are not provided.

If enacted, larger private employers (100 or more in-state employees) that had one or more workers enrolled in Medicaid last year would face a new annual charge calculated by multiplying the number of months those Medicaid-enrolled workers worked for the employer by a Medicaid capitation rate; that charge would be billed in four quarterly payments through the Employment Security Department, so those employers will see a new predictable recurring cost and franchisors — not individual franchisees — would generally be held responsible for franchise networks. Smaller employers, the federal government, state and most local government entities are excluded, so the direct financial impact falls mainly on sizable private employers meeting the apple health employer definition. State agencies will take on new duties: DSHS must calculate each employer’s bill by March 15 and ESD must notify employers by April 1 each year after the Health Care Authority says community engagement requirements are in effect, and the agencies must share data to do this; money collected goes into the state health care affordability account to be spent only after appropriation for programs like premium and cost-sharing assistance. Key practical uncertainties remain about exactly when the charge starts (it depends on the Health Care Authority’s determination and federal timing), the specific capitation rates to be used, and detailed counting or enforcement rules, so employers and agencies will need further guidance before final costs can be known.