On page 1, line 17, after "medicaid." insert "Middle class families are at the greatest risk because most have not saved enough to cover long-term care costs. When seniors reach the point of needing assistance with eating, dressing, and personal care, they must spend down to their last remaining two thousand dollars before they qualify for state assistance, leaving family members in jeopardy for their own future care needs."

On page 2, line 36, after "seamless;" strike "and"

On page 2, line 38, after "settings" insert "; and

(e) Program design focuses on the need to provide meaningful assistance to middle class families."

On page 3, beginning on line 32, after "dollars" strike all material through "approval," on line 33

On page 3, line 36, after "date." insert "The benefit unit must be adjusted annually at a rate no greater than the Washington state consumer price index, as determined solely by the state actuary. The state actuary, in consultation with the state forecast council and the department of social and health services, using data on relevant economic indicators and program costs, must determine adjustments to the benefit unit to assure benefit adequacy and solvency of the long-term services and supports trust account established in section 10 of this act. In determining adjustments to the benefit unit, the state actuary must consider the financial balance of program benefits and costs, in addition to sustainability."

On page 6, line 28, after "established." insert "The commission's recommendations and decisions must be guided by the joint goals of maintaining benefit adequacy and maintaining fund solvency and sustainability."

On page 8, line 19, after "(e)" strike "The" and insert "Providing a recommendation to the state actuary for the"

On page 15, beginning on line 17, strike all of section 17 and insert the following:

"NEW SECTION.  Sec. 17. A new section is added to chapter 43.09 RCW to read as follows:

By December 1, 2032, the state auditor must conduct a comprehensive evaluation of the long-term services and supports trust program established in chapter 50B.--- RCW (the new chapter created in section 21 of this act) and deliver a report, including a conclusion and recommendations for improvement to the legislature regarding:

(1) Program operations, including the performance of the long-term services and supports trust commission established in section 4 of this act;

(2) Program financial status, including solvency, the value of the benefit provided, and the financial balance of program benefits to costs;

(3) The overall efficacy of the program, based on the established goals under this act including, but not limited to:

(a) Delaying middle class families' need to spend to poverty to receive medicaid-funded long-term care;

(b) Strengthening the state economy through improving workforce participation;

(c) Reducing the caseload and expenditures of the state medicaid program on long-term care; and

(d) Obtaining shared savings through a medicaid demonstration waiver."

On page 20, line 20, after "chapter" strike "44.28" and insert "43.09"