Ask the Senate to Match the House Funding Levels! Thank the House for Their Work to Help Long Term Care!


The Legislature will convene for a Regular Session on January 10, 2022

The 2022 Legislative session will be a short 60-day session. During this period, Legislators will be making minor changes to the Biennial budget and policy changes. While revenues are up, the legislature is expected to make cautious and limited investments during the supplemental 2022 legislative session.  They will also likely look to use some of the higher revenues to replenish the state’s budget reserves.  However, with the current health care staffing shortages, combined with past inaction or action that has resulted in meager investments in long-term care Medicaid rates, we will advocate for significant funding increases. These funding increases are essential to stabilize assisted living and skilled nursing facilities, weakened by two years of battling COVID against a backdrop of supply shortages, escalating inflation, and a hyper-competitive labor market.                                                                          

Below is a preview of some of the key funding and policy areas we will be working on in this session.  

COVID Add Ons   

Throughout the pandemic, all of our long-term care settings have received a COVID-19 rate add-on to help providers cover increased expenses due to the pandemic, such as staffing costs, PPE, and other supplies. The disappearance of these add-ons is truly unthinkable and threatens the viability of some long-term care services providers, and certainly places further financial strain on all who are continuing to deal with outbreaks and staffing shortages.       

Governor Inslee’s proposed budget includes an extension of the current COVID-19 add-ons at their current levels for all providers through June 30, 2022. Beginning July 1, 2022, the rates will be stepped down by 20% every two quarters in FY2023 and FY2024. They will then be removed. 

We will be working with our long-term care partners to advocate for a permanent extension of the COVID add-ons during the legislative session. Since it is unlikely that we will revert to pre-pandemic prices on goods and services, essential worker wages and other benefits and bonuses must remain and increase to reflect the value of work performed, and enhanced infection control practices are here to stay. At a minimum, rates must not slip below current rates, inclusive of the COVID add-on.   


Workforce is the top-of-mind issue for all settings in the long-term care system. It is something that impacts each and every one of our members. The workforce shortage was a problem pre-pandemic. The challenges to hiring and retaining a qualified workforce have only become more complex during this pandemic. Providers are reporting longer job vacancies, higher labor costs, additional regulatory and operating requirements, and a lack of resources for addressing these challenges. The underfunded Medicaid payment system makes it difficult, if not impossible, to both compete for new workers and retain existing staff. Action is needed this session to address this crisis so we can start to rebuild.   

For our skilled nursing facilities, we are working with our partners at WHCA and SEIU to develop a low-wage worker add-on to improve wages paid to staff in skilled nursing facilities. The mechanics for this wage add-on have not yet been finalized, but the full cost of any wage increase must be funded by the state/federal government.  

Fundamental to this effort is an ongoing and concerted effort to improve upon the current payment system to more fully recognize the labor costs in all skilled nursing facilities while offering equitable opportunities to pay more to attract and retain more staff.    

For HCBS, including assisted living and adult day, we will be working with the Department on their request to use the additional FMAP dollars received by our state to increase worker wages in these settings. Details on these wage enhancements will be worked out with the legislature. 

In addition to funding increases, we will also be attempting to address price gouging and other predatory practices from staffing agencies. We will be pre-filing a bill that limits the rates which staffing agencies can charge providers while still making a profit and curtailing other objectionable hiring practices.   

Assisted Living Funding    

We will continue to push for a long-overdue substantial increase to the payment methodology. We will be advocating that beginning July 1, 2022; the assisted living methodology be funded at 77%. This will bring the rates up to equitable levels with the adult family homes rates.   

Our request legislation will then ask for the methodology to be funded at 85% on July 1, 2023.  At 85% of the model, the hourly wages paid would be $16.00, and every CARE Category would see a significant increase in their rates.   

We will also continue to work on increasing the Specialized Dementia Care rates so that we can see caseload growth as demand for this setting will continue to grow as our population ages.   

Skilled Nursing Funding  

When rates are updated through rebasing this June 2022, 2020, cost data will be used.  This ignores over two years’ of cost growth in the direct and indirect care components that are largely unaccounted for in the Medicaid rate. While the legislature did previously provide a one-time adjustment for inflation, the factor of less than 1.9 percent does not come close to reflecting real-world prices driven by the pandemic. We hope to ensure this is addressed in the state supplemental budget plan by increasing the inflationary factor (approximately 5.5%) used to adjust the cost report data when setting rates.     

The occupancy in skilled nursing facilities has been declining year over year for the past several years.  We have gone from 85% in 2015 to 77% in 2019 before the pandemic.  And since the pandemic, we’ve seen a further and significant drop in the census to 64% as reported in third-quarter 2021. Many Local Health Jurisdictions have held admissions due to outbreaks, and some facilities just don’t have the staff or resources to take new admits. We will look to address the occupancy penalty in the indirect care component by temporarily reducing it from 90% to 70% until June 30, 2023, to allow the census to rebuild. We were very pleased to see this funding request in the Governor’s proposed budget.  

Bold investments are needed in long-term care this year to carry us through the next wave of COVID outbreaks and work towards recovery over the next few years. We will be working hard this session to ensure the funding needs for long-term care are met.  More details to come as we get closer to the 2022 supplemental session.    

This Week in Olympia our weekly newsletter begins January 2022 and will be sent every Friday through the end of the session.   

LeadingAge Washington Responds to Pres Biden Plan March 4 2022



Member Advocacy 

Now is the time to start meeting with your Senator and Representatives. Your legislators will not know how to prioritize funding unless they hear from their constituents. They need to know the impacts, the needs, and personal experiences of your communities.  Visit our Advocacy Action Center  

Please make it a priority to advocate for Medicaid funding. Here’s how: 

Make sure you know the legislative district in which your community is located. Click here to for the legislative district look up.  

Call legislative assistants to book an appointment.  Here’s a roster of all legislators with office contact information. You will want to meet with both of your representatives and your senator. 

A LeadingAge Washington staff member will be available to join your meetings and will provide talking points and any other needed information ahead of time.  

For targeted advocacy, we will be using our new advocacy software SALSA. The SALSA software allows us to generate messaging and to target messaging to key legislators, all you need to do is enter contact information and your facility address and hit send. It’s also possible to expand your messaging to other districts based on the address of your personal residence, if different from the facility. Please watch for action alerts from us.