The bill adds a new section to chapter 74.09 RCW (Engrossed Substitute Senate Bill 6194) that makes rural hospitals located on federally recognized Indian reservations eligible for enhanced payments for inpatient and outpatient hospital services they provide to recipients eligible for medical assistance under chapter 74.09 RCW. Those payments are set at 150 percent of the fee‑for‑service rate, apply regardless of the beneficiary’s managed care enrollment status, and do not include any beds in the psychiatric unit. The payment provision takes effect January 1, 2027, and the new section expires January 1, 2029. The bill was read first on February 9, 2026, passed the House on March 6, 2026 (95-0), and passed the Senate on March 10, 2026 (49-0). The provided text does not define key terms such as “rural hospital,” “federally recognized Indian reservation,” or “fee-for-service rate,” does not identify which state agency will administer or make the payments, and does not show the exact new RCW section number or whether other limitations, funding sources, or related provisions appear elsewhere. These gaps are not resolved by the extracted text.

If enacted, rural hospitals located on federally recognized Indian reservations would receive higher payments for inpatient and outpatient services provided to people eligible for medical assistance under chapter 74.09 RCW: payments set at 150 percent of the usual fee‑for‑service rate. Those enhanced payments would start January 1, 2027 and end when the provision expires January 1, 2029, and they would apply even when the beneficiary is enrolled in managed care; payments would not cover beds in psychiatric units. The direct winners are those reservation-based rural hospitals, which would likely see increased revenue for covered services and reduced short‑term financial pressure. State Medicaid funding will need to cover the higher rates, but the bill text here does not say which agency will make the payments, how “rural hospital” or “federally recognized Indian reservation” are defined, nor where the money comes from, so the exact budgetary and administrative impacts remain unclear.