Thursday, September 17, 2020

ALTSA budget request for FY 2021-23


Reductions: Eligibility cuts, provider rate cuts, rental subsidies, wage savings for state employees, furlough days for state employees


This letter was shared by email from DSHS ALTSA:

Aging and Long-Term Support Administration
PO Box 45600, Olympia, Washington 98504-5600

September 16, 2020

Dear Interested Stakeholder, 

Today, Department of Social and Health Services (DSHS) Secretary, Cheryl Strange, announced the submission of the DSHS proposed budget to the Office of Financial Management (OFM) which included ALTSA’s budget proposal.

The COVID-19 pandemic has had a dramatic impact on the way in which we all support clients in need of long-term services and supports.  It has also significantly impacted state revenues.  This has forced budget prioritization resulting in difficult choices in both investments and reduction options.

In developing our budget priorities, ALTSA followed a few key principles that align with our Mission, Vision and Values:

  1. Ensure that our clients with the greatest need continue to receive services;
  2. Continue our priority of safety and protection of vulnerable adults;
  3. Preserve our services to the greatest extent possible;
  4. Preserve our workforce by proposing furloughs and implementing hiring, travel and purchasing freezes to avoid complete job loss.

Understanding the proposed budget and our priorities:

The agency submits two types of proposals for the next biennium’s budget: budget requests and reductions.  ALTSA budget requests include funding or savings for things like new programs and services or a change in the way existing services are delivered, some of which may require a change in statute. Reduction options are done at the direction of the Office of Financial Management in order to illustrate a 15 percent reduction in General Fund-State expenditures across all state agencies.

ALTSA Budget Requests:

COVID-19 Funding: Includes Infection Control and Client Services, In-home Provider Personal Protective Equipment (PPE), and the Transitional Care Center of Seattle, a DSHS-owned nursing home targeted for acute hospital long length of stay transitions. ($119.0M Total Funds: $61.5M GF-State; 105.9 FTE)

Nursing Facility Rate Methodology: adds the temporary rate changes that the 2020 Legislature made to the rate statute, adding an inflation factor to costs reported by nursing homes, and changing the rebasing from every other year to annually. ($22.9M Total Funds; $11.5M GF-State)

Behavioral Health Transitions: Increases Specialized Dementia and Behavior Specialty Program beds to continue client transitions from state hospitals to ALTSA community settings. ($16.9M Total Funds; $8.4M GF-State; 11.1 FTE)

Convert MTD to Medicaid State Plan: The five year Medicaid Transformation Demonstration waiver ends December 2021.  Having demonstrated that the Medicaid Alternative Care and Tailored Supports for Older Adults programs save money by addressing the increased demand for services in a way that provides more options for clients/family caregivers while also managing costs across populations, ALTSA requests funding continued services to support at risk individuals and family caregivers serving loved ones to delay and divert entry into more intensive Medicaid services.    ($81.4M Total Funds; $40.7M GF-State; 36.6 FTE)

Managed Care Organizations Medicaid Personal Care: Request for the cost of personal care for clients whose need for personal care is due to their psychiatric disability. These services are currently approved by the Managed Care Organizations (MCO) contracted by the Health Care Authority (HCA). This will streamline the process of authorizing and paying for personal care. ($14.0 Total Funds; $13.6M GF-State; 3.0 FTE).  It should be noted that the Health Care authority is also seeking funding for MCOs to provide long-term services and supports wrap around services to support individuals with significant behavioral health needs.

Reduction Options:

Furlough Savings: Continuation of the Governor's furloughs for specific job classifications, but assuming two furlough days per month. (-$36.5M Total Funds; -$17.6M GF-State)

General Wage Savings: Continuation of the Governor's modification of the 3% General Wage increase for EMS and WMS Positions. (-$2.0M Total Funds; -$1.0M GF-State)

Rental Subsidies: ALTSA will assist people who want to transition from nursing facilities more quickly by helping to cover the cost of rent for a limited time in their communities. The cost of in-home services, ALTSA staff, and the state-only rental subsidies is less than the GF-State portion of the nursing home Medicaid rate. (-$22.5M Total Funds; -$9.4M GF-State; 5.0 FTE)

Provider Rate Cuts: 2.4 percent rate cuts across the board for Medicaid providers, including in-home providers, nursing homes, adult family homes, adult day health, private duty nursing, enhanced service facilities and assisted living facilities. (-$145.2M Total Funds; -$66.6M GF-State)

Client Eligibility Cuts: This reduction option for temporary program eligibility changes would result in the loss of ALTSA services for over 12,000 people served in their own homes, community settings and nursing homes, and a reduction in the Department of Social and Health Services (DSHS) and Area Agency on Aging (AAA) staff due to a smaller number of clients receiving services. (-$805.3M Total Funds; -$385.6M GF-State; -69.6 FTE)

Please remember that this is just the first step in our budget process.  Using the information sent from DSHS and other agencies, the Governor will develop and submit a budget. Then the House and Senate will provide their budgets and from there a final conference budget will be negotiated and passed. 

Thank you for the work you do to support individuals in Washington who are in need of long-term services and supports.  For additional details on the ALTSA budget request, click here. 



 Bill Moss

Assistant Secretary
Aging and Long-Term Support Administration

DSHS: Transforming Lives