Summary:

The Long-Term Services and Supports Trust Program (Trust Program) is established to provide long-term services and supports benefits to persons who have paid into the Trust Program for a specific amount of time and who have been assessed as needing a certain amount of assistance with activities of daily living.

Beginning January 1, 2022, employees in Washington shall be assessed a premium of 0.58 percent of their wages. Washington residents receive "qualified individual" status if they are at least 18 years old and have paid the premium for either: (1) three years within the last six years, or (2) for a total of 10 years, with at least five of those years paid without interruption. For a year to count toward a person being deemed a "qualified individual" a person must have worked at least 500 hours during that year. Employees who demonstrate that they have long-term care insurance are exempt from paying the premium. Beginning January 1, 2025, a qualified individual may become an "eligible beneficiary" if the individual has been determined by the Department of Social and Health Services (DSHS) to require assistance with at least three activities of daily living.

Upon becoming an eligible beneficiary, a person may receive approved services through a benefit unit model. A benefit unit is the equivalent of up to $100, adjusted annually by no more than the Consumer Price Index, that the DSHS pays to a long-term services and supports provider for providing approved services to an eligible beneficiary. An eligible beneficiary may receive up to 365 benefit units over the course of the beneficiary's lifetime. Eligible beneficiaries may combine benefit units to fund approved services, as long as they do not exceed their lifetime limit. Partial benefit units may be retained by the eligible beneficiary if a day of care costs less than the value of the benefit unit.

Approved services are long-term services and supports, including adult day services, in-home personal care, assisted living services, adult family home services, nursing home services, care transition coordination, dementia supports, home safety evaluation, adaptive equipment, respite for family caregivers, transportation, home-delivered meals, education and consultation, relative care, professional service, and services to assist family members care for eligible individuals.

Approved services must be provided by a long-term services and supports provider that is qualified to provide the approved service and is registered with the DSHS to participate in the Trust Program. Long-term services and supports providers may be a home care aide, assisted living facility, adult family home, nursing home, in-home services agency, adult day health program, vendor, instructor, qualified family member, or other entity. Within 120 days of becoming a long-term care worker, a spouse or registered domestic partner who is a long-term care worker under the Trust Program for a spouse or domestic partner must receive 15 hours of basic training and six hours of focused training based on the spouse or domestic partner's needs. The spouse or domestic partner acting as a long-term care worker does not need to become certified as a home care aide.

The Trust Program is administered jointly by the DSHS, the Employment Security Department (ESD), the Health Care Authority (HCA), and the Office of the State Actuary (State Actuary). Each agency has the following responsibilities:

The DSHS shall make determinations regarding eligible beneficiary status, identify approved services that are eligible for payment, register long-term services and supports providers and discontinue the registration of those that fail to meet minimum qualifications or that violate Trust Program operating standards, disburse payments to long-term services and supports providers, prepare informational materials, provide customer service, provide support to the Long-Term Services and Supports Trust Commission (Trust Commission), track data relevant to the Commission, and establish rules and procedures for benefit coordination.
The ESD shall assess and collect employee premiums, assist the Commission in monitoring the solvency and financial status of the Trust Program, and perform investigations to determine compliance with premium payments.
The HCA shall make determinations regarding the status of a person as a qualified individual, assure that services are provided, and establish criteria for making payments to long-term services and supports providers.
The State Actuary shall perform actuary audits and valuations of the Long-Term Services and Supports Trust Account (Trust Account) at least biennially, make recommendations related to trust solvency, select and contract for necessary actuarial and research consultants, provide actuarial assistance to the Trust Commission and the Long-Term Services and Supports Trust Council (Trust Council), and make recommendations to the Pension Funding Council.

The Trust Commission is established and is comprised of:

eight legislators;
the Commissioner of the ESD;
the Secretary of the DSHS;
the Director of the HCA, who is a nonvoting member;
a representative of the organization representing the area agencies on aging;
a representative of a home care association that represents caregivers who care for private pay and Medicaid clients;
a representative of a union representing long-term care workers;
a representative of an association representing retired persons;
a representative of an association representing skilled nursing facilities and assisted living providers;
a representative of an association representing adult family home providers;
two individuals receiving long-term services and supports, or their designees, or representatives of consumers receiving long-term services and supports under the Trust Program;
a worker who is, or will likely be, paying the premium and who is not employed by a long-term services and supports provider; and
a representative of an employer whose members collect, or will likely be collecting, the premium.

The Trust Commission shall propose recommendations related to criteria for qualified individuals and eligible beneficiaries, minimum qualifications for the registration of long-term services and supports providers, improvements to the operation of the Trust Program, and the preparation of actuarial reports on the solvency and financial status of the Trust Program. In addition, the Commission must monitor agency administrative expenses. Beginning November 15, 2020, the Commission must submit annual reports to the Governor and fiscal committees of the Legislature related to administrative expenses. The November 15, 2025 report must include recommendations for a method of calculating future agency administrative expenses to limit administrative spending while allowing for sufficient funds to adequately operate the Trust Program.

The Trust Council is established and is comprised of the legislators and executive branch members who serve on the Trust Commission, as well as a representative from the Office of Financial Management. The Trust Council shall determine any adjustments to the benefit unit to assure benefit adequacy and the solvency of the Trust Account.

Every two years the Pension Funding Council may consider adjusting the premium to an amount no greater than 0.58 percent. If the premium rate is increased, the Legislature must notify each qualified individual by mail that the person's premium has been increased, describe the reason for the increase, and describe the plan for restoring the funds so that the premium rate is restored to 0.58 percent.

The DSHS must seek data to analyze the potential savings in Medicare expenditures resulting from the Trust Program. In addition, the DSHS must apply for a federal demonstration waiver to allow the state to share in savings to the federal government in Medicaid long-term services and supports and Medicare due to the operation of the Trust Program. By December 1, 2022, the DSHS must submit a report to the Office of Financial Management and the appropriate committees of the Legislature regarding the status of the waiver request.

Beginning December 1, 2026, the Commission must submit an annual report to the Legislature on the Trust Program. The report must include information about projected and actual Trust Program participation, the adequacy of premium rates, fund balances, benefits paid, demographic information on Trust Program participants, and the extent to which the Trust Program has resulted in savings to the Medicaid program through cost avoidance.

Monies collected from the premium must be deposited in the Trust Account. The Trust Account may only be used for supporting the administrative activities and payment of benefits related to the Trust Program. An appropriation is required for administrative expenses, but not for benefit payments.

Determinations made by the HCA and the ESD are subject to appeal procedures.

Beginning January 1, 2023, self-employed persons may elect coverage under the Trust Program. Those who elect such coverage may voluntarily withdraw from participation. The ESD may cancel elective coverage if the self-employed person fails to make the required payments or file reports.

The State Auditor's Office must conduct a comprehensive evaluation of the Trust Program and report its conclusions and recommendations for improvement to the Legislature by December 1, 2032. The report must consider the operations, financial status, and efficacy of the Trust Program.

Legislative findings are made related to the difficulty in obtaining coverage for long-term care, the need for long-term care, the cost of long-term care, the inability of seniors to rely on family caregivers, the cost to the state of providing long-term services and supports, the need for an alternative funding mechanism for long-term services and supports, and the need for the state to continue to promote consumer choice in selecting approved services and long-term care settings.

House	63	33
Senate	26	22	(Senate amended)
House	55	41	(House concurred)