Ensuring Equitable Access to Care for Washington’s Medicaid Patients

Washington state’s low Medicaid payment rates, combined with rising equipment and staffing costs, are making it increasingly hard for physicians to provide care to low-income patients. Doctors across the state are reporting patient risks and impacts, but because of the state’s inadequate reimbursement for services, physicians, practices, and medical groups cannot meet the need.

The Challenge We’re Facing

One out of every four Washington residents is on Medicaid—more than 2 million people. Despite having insurance, the state effectively limits their access to health care by not paying the cost of care.

When the state doesn’t pay for the cost of the physician visit, this means that many clinics and medical groups cannot see all the Medicaid patients who need them.

Washington’s specialty Medicaid reimbursement rates are among the worst in the nation, and rising costs of labor and equipment are making the situation worse. Further, Washington has not increased reimbursement across-the-board for health care services in decades and we are falling further behind.

This is not an individual doctor-and-patient problem, it’s a problem with our state’s Medicaid payment system.

The Good News

This is a systemic problem the state can solve. The best way to ensure that Medicaid recipients get the same expert medical care as everyone else is to increase reimbursement rates.

There is a way forward: In 2024, the Washington State Medical Association developed a solution: a “covered lives assessment,” which is a funding mechanism that would have brought approximately $500 million in federal funding to Washington state. This new revenue would have allowed the state’s Medicaid managed care organizations (MCOs) to increase reimbursements and allow physicians to treat more Medicaid patients.

We know this approach works: Physicians frequently cite low reimbursements as limiting their ability to see more Medicaid patients. Funding raised from the covered lives assessment would align Medicaid payments with Medicare patients for all health care services, improving access for critical care such as cancer diagnosis, joint replacement, x-rays and other necessary services.

House Bill 2476 was supported by hundreds of individuals, health care organizations, and physician groups. It was not included in the 2024 budget update, but the WSMA will be working with state agencies and other stakeholders to address their concerns so that this issue can be brought back to legislators and incorporated into the next biennial budget.

What Doctors and Clinics Are Saying

How to Get Involved

If you are a physician or advanced practitioner, the WSMA wants to support your ability to tell your legislators about your experience with low Medicaid reimbursements and how they hurt your ability to see and treat patients with Medicaid plans. Practice and clinic administrators are encouraged to share their stories, too. Stories from the health care workforce help lawmakers understand the relationship between reimbursement rates and access to care for Medicaid patients.

You can do this several ways: