State government today enters a new budget cycle fraught with spending cuts, accompanied by a quiet restructuring of agencies that deal with health care.
Gov. Chris Gregoire got a major health care merger rolling more than a year ago with an executive order. But with the new budget cycle, the joint federal and state-funded Medicaid program for the poor is moving out of the sprawling Department of Social and Health Services and landing in the Health Care Authority.
The authority is a smaller and less-well-known agency that already provides health insurance programs for state employees, dependents and retirees.
“Patients won’t notice so much,” Doug Porter, the state Medicaid director, said. “I’d say from now until December – over the next six months there will be a series of adjustments we’ll be making until the dust settles.”
One goal of the merger is to streamline the health care bureaucracy. Another is to improve care over time, eliminating unnecessary or duplicate medical procedures, and to better manage the care of chronically ill patients.
Porter said 5 percent of patients are chronically ill and consume up to 50 percent of the cost of care. He said savings can be made if chronic conditions such as diabetes and heart ailments are treated using methods proven to work well and cost less.
Several other changes are coming to state government or state law today as a result of bills approved this year by the Legislature. Among the changes:
• 3 percent pay cuts for about 54,500, or 90 percent, of general-government agency workers. This year’s cuts include 3 percent reductions in pay and hours worked – the result being that affected employees will see 3 percent smaller paychecks while getting an additional 5.2 hours a month off – credited as prepaid leave.
• Consolidation of parts or all of five agencies (including Information Services, General Administration, Personnel, and Financial Management) into two new agencies – a Department of Enterprise Services and a Department of Consolidated Technology Services. These moves don’t take full effect until Oct. 1.
• New state parks fee for vehicles. Legislation lets residents pay $30 a year for a new Discover Pass giving unlimited admission to state parks and other state recreation areas.
• Two laws temporarily suspend cost-of-living raises for public school teachers and improvements in public school class sizes.
• A fee of $1 to $11 per patient takes effect for nursing home providers. House Bill 1738 levies the fee as a way to generate extra federal matching funds for Medicaid; the matching funds, in turn, will be used to avert cuts in the state’s payments to nursing homes for the care of Medicaid clients.
• A new infraction for drivers cited for negligent driving in accidents in which a “vulnerable user of the public way” – such as a pedestrian, horse rider, cyclist or user of a motorized scooter or wheelchair – is injured or killed.
• House Bill 1371 gets rid of more state boards and commissions – continuing on a smaller scale what Gregoire proposed a few years ago. The latest boards to expire or be transferred into other boards include the Eastern State Hospital Board, Firearms Range Advisory Committee, Performance Agreement Committee, Salmon Stamp Selection Committee, Western State Hospital Board, Home Care Quality Authority (moving to DSHS), and the Migratory Waterfowl Art Committee (moving to the Department of Fish and Wildlife).