DSHS Releases Details on the 2019-2021 Operating Budget

DSHS Releases Details on the 2019-2021 Operating Budget

May 21, 2019

Dear Interested Stakeholder,

Today, Governor Inslee signed into law the operating budget bill for the 2019-21 biennium. You can find detailed information about the budget on the Legislative Evaluation & Accountability Program (LEAP) website

When the Department submitted our agency request last fall, our top priority was to fund critical or emergent issues required to comply with state and federal laws. We also requested funding for several other program priorities; many of these are reflected in the final budget.

Highlights from the enacted 2019-21 (2-year) budget that impact ALTSA include:

  • Long-Term Services and Supports (LTSS) Trust: Second Substitute House Bill 1087 (Long-term services & supports) establishes an employee payroll premium that will fund the provision of LTSS benefits for eligible individuals. ALTSA will be responsible for eligibility assessments for applicants requesting benefits when the program goes live in 2025. ($2.4M LTSS Trust Acct; 7.3 FTE)
  • Behavioral Health Reform (Additional Enhanced Discharge, ESF Bed Capacity, Dementia Beds, and AAA Case Management): ALTSA continues to play a significant role in transforming the delivery of behavioral health services in Washington, relying less on the large state hospitals in favor of community placements. The budget funds 340 new community placements in all, including Enhanced Service Facilities, Adult Family Homes, Assisted Living Facilities, Skilled Nursing Facilities, supportive housing, 100 new Specialized Dementia Care beds and a small amount of additional staffing resources for Area Agencies on Aging in the 2019-21 biennium. ($20.9M GF-S; $38.3M Total Funds; 17.6 FTE)
  • Supported Living (SL) Investigators: Additional investigators will be added to address provider practice complaints related to abuse, neglect and financial exploitation and abandonment of people with developmental disabilities residing in their own homes. The entire SL investigation program in Residential Care Services will change from General Fund-State and federal match funding to be funded by an annual provider certification fee, which is paid back to the providers in their daily rate over the course of the year, resulting in a GF-S savings.  (-$2.3M GF-S; $2.1M Total Funds; 5.4 FTE)
  • Collective Bargaining Agreements: New collective bargaining agreements that affect ALTSA employees and providers, including:
    • Washington Federation of State Employees: General classified state employees ($10.6M GF-S; $19.8M Total Funds)
    • SEIU 1199: State employee nurses ($1.7M GF-S; $3.2M Total Funds)
    • SEIU 775 NW: Individual Provider in-home care workers ($48.8M GF-S; $111.1M Total Funds)
    • Agency Parity: While not bargained separately, in-home care agencies receive comparable changes to the SEIU 775 Individual Provider bargaining agreement. ($19.5M GF-S; $44.2M Total Funds)
    • Adult Family Home Council: Owners of Adult Family Homes (AFH) bargain with the state for daily rates and special programs. ($29.2M GF-S; $65.6M Total Funds)
  • Vendor Rate Increases:  There are several key areas where the Governor made targeted investments for key Medicaid service providers:
    • Nursing Homes: The Quality Enhancement component of the nursing home rate is increased from $2.32 per client day to $3.67. ($5M GF-S; $10M Total Funds)
    • Assisted Living: The Assisted Living Facility Medicaid rate is increased. ($12.2M GF-S; $27.6M Total Funds)
    • Nursing Services: Rates are increased ten percent for in-home Medicaid nursing services and adult family home private duty nursing. ($2.2M GF-S; $4.7M Total Funds)
    • Agency Provider Admin Rate: Home care agencies receive a $0.05 per hour administrative rate increase. ($0.6M: GF-S; $1.4M Total Funds)
    • Adult Day Rate: Adult Day Health and Adult Day Care rates are increased. ($0.8M GF-S; $1.5M Total Funds)
  • Electronic Visit Verification: Home care agencies receive a rate increase to pay for systems to electronically verify and report the delivery of personal care services, as required by the federal Centers for Medicare and Medicaid Services. ($4.8M GF-S; $11M Total Funds)
  • Dementia Action Collaborative: ALTSA will contract with an organization that provides legal services and advanced care planning for individuals with dementia and their families, as recommended by the Dementia Action Collaborative. ($0.2M GF-S)
  • Homeless Personal Care Services: One-time funding is provided to establish a pilot project to provide personal care services to homeless seniors and persons with disabilities in a homeless shelter. ($0.2M GF-S)

If you have questions regarding the 2019-21 biennial budget or other results of the legislative session, please contact Kristi Knudsen at (360) 725-2288 or by email at kristi.knudsen@dshs.wa.gov.  

Thank you for the work you do each day to advocate for individuals in need throughout our state. 


Bill Moss, Assistant Secretary

Aging and Long-Term Support Administration


DSHS: Transforming Lives