[{"_1":2,"_112":-5,"_113":-5},"loaderData",{"_3":4,"_26":27},"root",{"_5":6,"_17":10,"_18":19,"_20":21,"_22":10,"_23":-5,"_24":-5,"_25":10},"user",{"_7":8,"_9":10,"_11":10,"_12":-5,"_13":-5,"_14":15,"_16":-5},"roles",[],"isAuthenticated",false,"isPremium","planName","subscriptionStatus","featureFlags",{},"insightsBudget","isDevelopmentHost","userPreferences",{},"recaptchaSiteKey","6LcvOJcUAAAAAHsB-gPGfGktcRlKpH7OTIU_dMTD","isImpersonating","impersonation","affiliateStatus","isFreedomPortal","routes/v2/article/layout",{"_28":29,"_30":31},"notFound",true,"relatedArticles",[32,76,88,100],{"_33":34,"_35":36,"_37":38,"_39":40,"_41":42,"_43":44,"_45":46,"_47":48,"_49":50,"_51":52,"_53":54,"_55":56,"_57":58,"_59":60,"_61":62,"_63":64,"_65":66,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},"mediaId",6380621,"mediaKeyId","2130359-383a17054daa8975ec5beb87df89ae4d","parentId",2130359,"title","Adult family homes and nursing providers cite rapid demand growth, bed‑hold gaps and workforce pressure","audioSeconds",1606,"startMs",5255000,"endMs",6861000,"viewUrl","/Search/View?dp=1&key=2130359-383a17054daa8975ec5beb87df89ae4d&start=5255&end=6861","thumbnailUrl","https://assets.pipeline.soar.com/2130359-383a17054daa8975ec5beb87df89ae4d/thumbnail_5255000.jpg","articleUrl","/articles/6380621/Washington/Adult-family-homes-and-nursing-providers-cite-rapid-demand-growth-bedhold-gaps-and-workforce-pressure","mediaUrl","https://secure.pipeline.soar.com/6380621-134033d6f9a92c50e6dce4a31e529f26/orig.mp4?Expires=1771192764&Signature=UJ3ZtNas4ILiC-wEQMk7Xs-fDNlzLkfasprkHOuLnMfiPzydMjr-RNUOcNSSI5xB2kbP5fpy9k6TT3JCO9RQm4U~S4RKX9xdCqzXgr6w1kivb-fDo87K5rloeUC9KnDKdWiv1DTDh3LxhM9b91dG313Si~MVLYKaHQtOX7UvxNaDAQz0LQoBSwP4mt3Dr4P0qB-LsSUGg3q4G0Ae-Pa6GA5Tm0JprSfaWVF5eIn8UqnPH5yY7WJC5emvfTme9ql5DIKB0FBowEeKk6RFU4Or86WoZ9CKxA53peAsNRuwWvi5EELhTr9R27HxATIdiqUAAhjyq0NDNy281c7A3ymqIg__&Key-Pair-Id=KUT5TJCACFTXG","author","Senate Health & Long-Term Care","date","2025-01-17T00:00:00Z","article","Adult family homes, assisted living and skilled nursing operators told the Senate Health & Long Term Care Committee that demand for home‑and‑community‑based long‑term services is rising, that Medicaid covers the majority of residents in those settings, and that payment, workforce and insurance costs are creating bottlenecks that push patients to remain in hospitals longer.

John Ficker, executive director of the Adult Family Home Council, said adult family homes have grown substantially and now number more than 5,000 facilities across Washington with nearly 30,000 beds. He said roughly 91% of adult family homes are contracted to provide Medicaid services and that about two‑thirds of contracted beds are occupied by Medicaid or state‑funded residents. \"If just 5% of our population was moved from the adult family home to a skilled nursing facility, an annual increase in expenditure by the state would be a minimum of $20 million,\" Ficker said.

Ficker described adult family homes as small, often family‑run residential settings that can care for higher‑acuity residents, including people with dementia, brain injury or developmental disability. He urged changes to several program details: faster Department of Health credentialing timelines, mitigation funds for unpaid client participation (to mirror landlord protections), and an increase in the so‑called bed‑hold payment. Under current practice he described, the first seven days of a bed hold pay roughly 70% of a resident's base daily rate, but for days eight through 20 the payment is $15 per day. Ficker said a proposed increase to $75 for days 8–20 would be modest relative to the costs of keeping patients in hospitals.

Pete Wilkin, director of operations for Nightingale Healthcare, described operational constraints in skilled nursing and assisted living. He said his company operates multiple skilled nursing and assisted living facilities across several counties and that facilities serve both short‑term post‑acute patients and long‑term residents, the latter of whom rely heavily on Medicaid. \"Reimbursement is the other R word,\" Wilkin said, explaining that narrow margins, mixed payer sources and administrative denials create incentives that can keep people in higher‑cost settings.

Wilkin gave examples of regulatory and liability constraints that can limit placement options and complicate admissions. He said regulatory requirements intended to ensure resident safety sometimes create practical barriers to admitting patients — for example, accommodations and staffing to permit a resident who smokes to do so safely — and that escalating liability insurance costs and litigation risk increase operating expense and narrow options.

Both speakers described workforce pressure across home‑and‑community settings and post‑acute providers: tight labor markets, credentialing delays and limited access to training or testing were cited as recruitment and retention barriers. Ficker also noted a collective bargaining agreement for adult family home workers that raised compensation in 2024 and asked the Legislature to support funding that reflects recent contract settlements.

Lawmakers asked about how adult family homes, assisted living, skilled nursing and hospitals can better coordinate to ease discharge bottlenecks. Witnesses recommended modest targeted investments in bed‑hold payments, operational supports for workforce entry, and stabilization of Medicaid contracts that underpin provider capacity. Ficker indicated a willingness to pilot expanded developmental‑disability placements if funding is available.","mediaType","Video","parentTitle","Senate Health & Long-Term Care - 1/17/2025 8:00 AM","oneSentenceSummary","Adult family homes, assisted living and skilled nursing providers told the Senate Health & Long Term Care Committee that demand for home‑and‑community‑based long‑term services is rising and that payment, workforce and liability pressures are creating placement and discharge bottlenecks.","taxTitle","Health & Long Term Care, Senate, Legislative Sessions, Washington","taxId",20503,"location","Washington","headline","","shortSummary",{"_33":77,"_35":36,"_37":38,"_39":78,"_41":79,"_43":80,"_45":81,"_47":82,"_49":83,"_51":84,"_53":85,"_55":56,"_57":58,"_59":86,"_61":62,"_63":64,"_65":87,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6380626,"Hospitals warn of thin reserves, high occupancy and discharge bottlenecks",1607,3495000,5102000,"/Search/View?dp=1&key=2130359-383a17054daa8975ec5beb87df89ae4d&start=3495&end=5102","https://assets.pipeline.soar.com/2130359-383a17054daa8975ec5beb87df89ae4d/thumbnail_3495000.jpg","/articles/6380626/Washington/Hospitals-warn-of-thin-reserves-high-occupancy-and-discharge-bottlenecks","https://secure.pipeline.soar.com/6380626-71f9cbd28a6925cc4aa78db570989939/orig.mp4?Expires=1771192764&Signature=Spqd~JtdkkZSFQV5z~2J9e25eQOHVqxoN-vetvuMlkqriYCIEX6FcKDRPGySQL9SsGihFW1MydtlnW5iuIEIgGLh2a2Kr7AVAMbsL1BgRnOQo~zhU1l1h3BndN8C46yteGbZm0gGAiYlh9uP4Te7~9VIp86NJrWfLrbWLtFAyARP2GJt2lJcYsyN~H5JwpKKWwxkFMD8PcE43aBzHuRlQFHFhQFDY970Pct3DKkFypxaK5Yy-ugvVr6mDp8POvG6hJwD2kdEsG1XkmvCRAFEfCn8XjNpru8zwulIBIhrlfXsUbafkFYoZ~TTQMWrBanSQ4ATWZ9wUC1vqH~b1ZPuyQ__&Key-Pair-Id=KUT5TJCACFTXG","Hospital leaders told the Senate Health & Long Term Care Committee that Washington hospitals are operating near capacity, have seen four years of financial losses and continue to face complex discharge and workforce challenges that reduce bed availability.

Florence Chang, president of MultiCare Health System and chair of the Washington State Hospital Association's public policy committee, said Washington's 101 community hospitals are part of a broad health ecosystem that depends on primary care, long‑term care and outpatient specialty services. \"Hospitals are operating very high in terms of 96% occupancy,\" Chang said. \"When an acute care bed is taken up by a patient who could be discharged, it causes longer emergency department wait times.\"

Maryann Keene, CEO of Ocean Beach Hospital and chair of WSHA's rural hospital committee, told the committee hospitals provided substantial volumes of care last year: emergency department visits measured in the millions, hundreds of thousands of inpatient stays and roughly 75,000 births. She said hospitals are treating increasingly complex patients and that length of stay is growing: since 2019 stays for complex patients rose about 35%.

Keene and Chang described the effect of complex discharge — when patients are clinically ready for discharge but cannot move to a post‑acute setting such as a skilled nursing facility or an adult family home — and noted the average hospital cost to care for a patient who no longer needs inpatient services is roughly $1,000 per day. The legislature directed investments in recent sessions to reduce that backlog, Keene said, and the number of complex discharge patients decreased from pandemic highs but remains elevated.

Shailene Whittaker, senior vice president for government affairs at the Washington State Hospital Association, presented state financial aggregates showing hospitals' operating margins and cash reserves deteriorated after the pandemic. WSHA reported that hospitals had a negative 5.2% operating margin in 2023 and lost approximately $1.7 billion; preliminary 2024 numbers show an improved but still negative operating margin (around -1.3%) and a $400 million loss after state safety‑net payments began flowing. Hospital reserves (days cash on hand) also fell; bond rating guidance generally considers about 200 days cash on hand healthy, and many Washington hospitals are well below that benchmark.

Committee members asked about insurer payment practices and the effect of claims denials and slower payments on hospital liquidity. Whittaker and Chang said reimbursement delays and greater denial rates since the pandemic have extended revenue cycles and strained reserves. \"Once a payment is denied, to get paid for that care sometimes can take six months,\" Whittaker said.

Panelists also described structural factors that affect bed availability. Washington has fewer hospital beds per capita than most states, a trend driven in part by a long‑term shift to outpatient care. WSHA cited a Kaiser Family Foundation ranking that placed Washington near the bottom nationally for beds per 1,000 residents. The association said having fewer beds, higher acuity patients and limited post‑acute capacity together compress the system and raise the risk of service reductions if financial pressures continue.

Hospital leaders thanked the Legislature for the 2023 safety‑net assessment and related payments but cautioned those funds and the larger hospital stabilization efforts remain at risk if the Legislature reduces funding amid a tight state budget. They asked lawmakers to weigh the financial strains when considering cuts and to prioritize interventions that improve throughput, stabilize post‑acute capacity and support workforce recruitment.

Lawmakers acknowledged the need to address upstream drivers of hospital capacity, including primary care and long‑term care placement, and asked presenters about options to shore up reserves, speed claims payments, and reduce administrative barriers to discharge.","Hospital leaders told the Senate Health & Long Term Care Committee that hospitals statewide are running near capacity, face shrinking reserves and longer patient stays, and that limitations in post-acute settings and payment rates are constraining bed throughput and financial stability.",{"_33":89,"_35":36,"_37":38,"_39":90,"_41":91,"_43":92,"_45":93,"_47":94,"_49":95,"_51":96,"_53":97,"_55":56,"_57":58,"_59":98,"_61":62,"_63":64,"_65":99,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6380631,"Washington lawmakers hear plan to boost primary care spending, shift payment toward team-based care",3496,99000,3595000,"/Search/View?dp=1&key=2130359-383a17054daa8975ec5beb87df89ae4d&start=99&end=3595","https://assets.pipeline.soar.com/2130359-383a17054daa8975ec5beb87df89ae4d/thumbnail_99000.jpg","/articles/6380631/Washington/Washington-lawmakers-hear-plan-to-boost-primary-care-spending-shift-payment-toward-team-based-care","https://secure.pipeline.soar.com/6380631-a512187792071396cd98ed37e65af534/orig.mp4?Expires=1771192764&Signature=VtMi1nEnrpgd06UBqmkb4l48s6KWia--ivQG9N8j7yHdUp6Js4wzKJZbDpHKhJYQLD1S4vcQVPOFAAm24~CoNdxW0y39uAqwak2WlcNn3wFaKfedWoyhA9TPtzsQFFyVJLIVfYHzNMgb7Zzlcp3g9He7QNacBO8Uru~VG3f2-O7x0DKPkYV-whvF1VxnoXSRBBc32eC2SJPDVDGcQqZPEcO596wQQk6PtVFDY0d98VgF1En-gOnn-R7PBgmwPhV~NNrqHMUKQvcaLduzFe~BLehqB2Kly8JgM82gzpWQje5hyAbqEzy3d13B8Vx-lahE1Je3KYhshQXHEdAQKVhXXw__&Key-Pair-Id=KUT5TJCACFTXG","The Senate Health & Long Term Care Committee on Friday heard that Washington currently spends about 6% of total health expenditures on primary care and that state leaders and health systems must change payment models to expand access.

Dr. Judy Zirzen Thule, chief medical officer at the Health Care Authority, told the committee that primary care investment in Washington remains low and that current fee-for-service payment fragments care and discourages team-based models. \"Primary care spending is just under 6% of total expenditures in Washington state,\" Zirzen Thule said, adding that the legislature set a 12% target in 2022 through Senate Bill 5589.

The gap between current spending and the 12% goal matters because primary care teams — clinicians, medical assistants, community health workers and care coordinators — need payment structures that cover non‑billable team activities, speakers said. \"The best primary care isn't just a doctor or a nurse interacting with you. It's a whole team,\" Zirzen Thule said.

Sean Graham, director of government affairs at the Washington State Medical Association, told senators that physician practices face staffing shortages, administrative burdens and low Medicaid reimbursement that drive practices to limit Medicaid panels. He said a WSMA membership survey found more than 90% of respondents described prior authorization as \"very burdensome,\" and about 63% of practices are limiting their Medicaid patient panels. \"More than 80% say they would be able to maintain and increase Medicaid panels if rates were raised to Medicare levels,\" Graham said.

Physician and primary care groups urged three broad strategies: (1) increase the share of total health spending that goes to primary care; (2) move payment away from visit-level fee‑for‑service toward per‑member/per‑month or other value‑based models that cover team-based services; and (3) align payers across commercial plans, Medicaid managed care and public employers.

Dr. Katrina Ryu, an osteopathic family physician with the Washington Academy of Family Physicians, said simplification and aligned, value‑based payments would free clinicians from administrative work and support full‑scope family medicine. \"We simplify by moving away from procedure widget based payments and toward payments based on value,\" Ryu said.

The committee also heard details on how primary care spending is measured and what can change. The primary care advisory committee to the state's health care cost transparency board recommended a revised, claims-based definition that excludes obstetrician–gynecologists and excludes urgent care and emergency department episodes from the primary care category. The committee recommended an annual increase target (roughly 1% per year, consistent with other states) and a policy to raise Medicaid primary care reimbursement to no less than 100% of Medicare by 2028.

Community health center leaders described how federally qualified health centers deliver comprehensive primary care and social supports to low‑income patients and Medicaid enrollees. Lisa O'Hallum, CEO of HealthPoint, said Washington's 28 health centers operate more than 400 delivery sites and served nearly 700,000 Medicaid patients in 2023. Rhonda Hoff, CEO of Yakima Neighborhood Health Services, said health centers employ about 13,000 people statewide and house roughly half the state's residency slots, making them central to workforce training and care access.

Committee members asked about implementation details, including how to scale per‑member payment models, the role of workforce investments such as family medicine residency slots, and whether raising Medicaid rates would reduce reliance on emergency departments. Panelists noted prior action from the 2023 Legislature to modernize prior authorization and the continuing work of federal and state primary care transformation initiatives.

The presenters recommended incremental targets and multi‑payer collaboration while cautioning that the state's budget constraints will shape what can be adopted this session. \"A lot of payment decisions impact access to primary care,\" Zirzen Thule said. \"It doesn't have to be new money; it could be reinvestment of current dollars.\"","State health officials, physician groups and community health centers told the Senate Health & Long Term Care Committee that Washington spends roughly 6% of health dollars on primary care, well below the legislature's 12% goal, and urged multi-payer payment changes, higher Medicaid rates and support for team-based models to expand access.",{"_33":101,"_35":36,"_37":38,"_39":102,"_41":103,"_43":104,"_45":105,"_47":106,"_49":107,"_51":108,"_53":109,"_55":56,"_57":58,"_59":110,"_61":62,"_63":64,"_65":111,"_67":68,"_69":70,"_71":72,"_73":74,"_75":74},6380617,"Committee refers Senate Bill 5178 on sodium nitrate transfers to another committee without recommendation",94,6842000,6936000,"/Search/View?dp=1&key=2130359-383a17054daa8975ec5beb87df89ae4d&start=6842&end=6936","https://assets.pipeline.soar.com/2130359-383a17054daa8975ec5beb87df89ae4d/thumbnail_6842000.jpg","/articles/6380617/Washington/Committee-refers-Senate-Bill-5178-on-sodium-nitrate-transfers-to-another-committee-without-recommendation","https://secure.pipeline.soar.com/6380617-73733f055272d8674715bd7ac9d2544f/orig.mp4?Expires=1771192764&Signature=efx8ling7n6oQj2BlCOz8bAmT5vw2MrY3p~VXwUpR8rX7ghZNpZ2yPC0hpfOAhFWZVM33mALiYclAVxUjagrUpgwmSDjdFUDZsvQofAjBVxvmPrA4LLju55xRe6seEe23o3Sx-LK0hsUc-1xDVzLTh8mRpOEOS6RN~F~-bm4S5Nt62zYEU9rWKZ48SqXCXeeDeo0d1PExUU-P8qV3mWXTINDcxQ3aZiO59hLXPylm8US7Q39oY1xcRhm7QrAV7TpBAYx7wyey3OvfVxVTrWBDGgQHeYIzDQDiLRz~M75HnmTPda3PIEEc-jc3BjKJizgdqQQUxidaV4oZFM~lHEPzg__&Key-Pair-Id=KUT5TJCACFTXG","The Senate Health & Long Term Care Committee moved a procedural referral of Senate Bill 5178 to the Business, Financial Institutions & Trade Committee and voted to send the bill without recommendation.

Greg, staff to the committee, briefed members that Senate Bill 5178, sponsored by Sen. Trudeau, \"sets conditions for business entities to sell or transfer products containing certain levels of sodium nitrate, including acquiring proper labeling of those products.\" He said the bill \"is up for rereferral without recommendation to the Business Financial Institutions and Trade Committee.\"

Vice Chair Orwell moved that the committee refer the bill to Business, Financial Institutions & Trade \"without recommendation.\" The committee conducted a voice vote. The clerk called for ayes and nays; members present voiced \"aye,\" and no opposing \"nay\" was recorded on the floor. The chair announced the bill had been referred \"subject to signatures.\" The committee then adjourned.

The transcript records the rereferral motion and the staff briefing; no floor roll‑call tally was recorded in the hearing transcript.","The Senate Health & Long Term Care Committee voted to rerefer Senate Bill 5178, which would regulate transfers of products containing certain levels of sodium nitrate, to the Business, Financial Institutions & Trade Committee without recommendation after a brief staff briefing and no recorded opposition.","actionData","errors"]

Article not found

Adult family homes and nursing providers cite rapid demand growth, bed‑hold gaps and workforce pressure

Hospitals warn of thin reserves, high occupancy and discharge bottlenecks

Washington lawmakers hear plan to boost primary care spending, shift payment toward team-based care

Committee refers Senate Bill 5178 on sodium nitrate transfers to another committee without recommendation