Washington Budgeted $20 Million for 300 People’s Long-Term Care. It Will Cover 173.
- $20,000,000 Washington legislators appropriated this year for a new “State-Funded Long-Term Care for Noncitizens” program, administered by the Department of Social and Health Services — WA HCA program page; KUOW, Aug. 10, 2026
- 173 people the money will actually cover — not the roughly 300 lawmakers assumed when they wrote the budget for FY2026-27 — KUOW; Chinook Observer; Clark County Today, Aug. 10-11, 2026
- $115,600 the resulting per-enrollee annual cost — in line with national long-term-care benchmarks, where skilled nursing commonly runs $100,000-$150,000+ a year — Civic Intelligence calculation from DSHS enrollment figures
- ~14,000 Washington Medicaid enrollees state officials project will lose coverage statewide when a federal eligibility cut takes effect Oct. 1, 2026 — about 1,500 of them in long-term care specifically — DSHS; KOMO News, 2026
- $1,000,000 total federal funding Congress appropriated nationally for FY2026 CMS implementation of that same eligibility change — DSHS Benefits and H.R. 1 guidance
Washington State lawmakers built this year’s budget around an assumption: $20,000,000 would be enough to cover long-term care for roughly 300 noncitizens under a new state-funded program, with enrollment ramping toward 1,200 people and roughly $100,000,000 a year once the 2027-29 biennium begins. The Department of Social and Health Services now administers that first $20,000,000. It will not reach 300 people. It will reach 173.
The gap is not a story about missing money or hidden theft. Divide $20,000,000 by 173 enrollees and the per-person cost comes out to roughly $115,600 a year — a figure that tracks with what skilled nursing and long-term care actually cost nationally, where $100,000 to $150,000 or more a year is common. The real story is a planning failure: legislators wrote a budget assuming a caseload nearly twice the size of the one the money will actually serve, at a moment when the population needing this coverage is about to grow sharply for reasons entirely outside Olympia’s control.
That reason arrives on October 1, 2026. A federal law signed a year earlier strips Medicaid eligibility from thousands of Washington residents who currently qualify — and the state’s $20,000,000 program exists specifically to catch some of the people that cutoff will drop.
The State-Funded Long-Term Care for Noncitizens program was approved during this year’s legislative session and is run day-to-day by DSHS. It covers services like nursing-home care and in-home caregiving for people who would qualify for Medicaid-funded long-term care except for their immigration status. When lawmakers wrote the $20,000,000 line item, the planning assumption was straightforward: roughly 300 enrollees in the current fiscal year, growing to about 1,200 people and $100,000,000 annually once the 2027-29 biennium begins. DSHS’s actual enrollment math lands far short of that first-year target — 173 people, not 300 — even though the dollar amount appropriated has not changed.
State Rep. Nicole Macri (D-Seattle) laid out the arithmetic publicly: the $20,000,000 lawmakers approved this session simply does not stretch to the 300-person caseload the budget assumed, and closing that gap will require the state to find more money elsewhere. Macri has called on Gov. Bob Ferguson’s (D-WA) office to help locate additional funding before the shortfall becomes an enrollment freeze in its own right. As of publication, Ferguson’s office had not announced additional funding or responded publicly on the record.
The program exists because of a federal law, not a state one. The One Big Beautiful Bill Act (H.R. 1, Public Law 119-21), which President Trump signed on July 4, 2025, strips Medicaid eligibility from refugees, asylees, and several other previously-qualified noncitizen categories, effective October 1, 2026. Washington officials project roughly 14,000 state Medicaid enrollees will lose coverage statewide once the cutoff hits — about 1,500 of them enrolled in long-term care specifically, the exact population this $20,000,000 fund is meant to catch. The state is prioritizing the roughly 100 people in facility-based nursing care over the larger group receiving care at home, who are more likely to simply lose coverage when the cutoff arrives.
The federal government’s own preparation for this change is comparatively small: Congress appropriated just $1,000,000 nationally for CMS to implement the eligibility change in fiscal year 2026 — against the tens of millions Washington alone is now spending, and the hundreds of millions several states combined are spending, to backstop the coverage loss the federal law creates. DSHS Secretary Angela Ramirez has been blunt about what is coming: “When this cut hits, it’s going to be harmful.”
“When this cut hits, it's going to be harmful.”
DSHS Secretary Angela Ramirez · 2026
SEIU 775, the union representing Washington’s home-care and nursing-home workers, lobbied for the $20,000,000 appropriation in the first place. Secretary-Treasurer Adam Glickman called the resulting 173-person reality “disappointing and frustrating,” and was direct about the consequence for the people the fund was supposed to reach but won’t: “The reality is people will get sicker.”
The video above covers a related but separate program — not the $20,000,000 long-term-care fund at the center of this story. Washington’s Apple Health Expansion is a larger, older initiative: $150,000,000 budgeted for the 2025-27 biennium, capped at 13,000 enrollees, with more than 5,000 people on a waitlist before the state closed enrollment entirely in December 2025. It is run through the Health Care Authority under Director Ryan Moran, whom Gov. Ferguson (D) appointed in August 2025 and who co-administers programs adjacent to DSHS’s long-term-care fund.
The two programs should not be conflated — different agencies, different budgets, different populations — but together they show a state running multiple, concurrent, state-funded health programs for noncitizens at the same time it is trying to plug a hole a federal law is about to open. Washington is not alone in that approach. Six jurisdictions currently fund noncitizen health coverage with their own tax dollars and were named in the same CMS audit: California, Colorado, Illinois, Oregon, Washington, and the District of Columbia.
Washington’s planning gap is a small piece of a much larger federal finding. A CMS audit identified a combined $1,351,204,127 improperly spent in federal Medicaid dollars across the six states that run noncitizen coverage programs. California accounts for the largest share by far, at roughly $1,300,000,000. CMS Administrator Dr. Mehmet Oz described the pattern he found in blue states generally, aimed squarely at Gov. Gavin Newsom (D-CA): “I began to realize that stealing money from Medicaid is not a flaw for a lot of states, it’s a feature. They call it ‘Medicaid-ing it.’”
“I began to realize that stealing money from Medicaid is not a flaw for a lot of states, it's a feature. They call it 'Medicaid-ing it.'”
Dr. Mehmet Oz · CMS Administrator · 2026
Illinois improperly spent about $30,000,000 and cut its noncitizen coverage program in March 2025. Oregon’s improper spending came to roughly $5,500,000. House Oversight Committee Chairman James Comer (R-KY) sent investigation letters on September 3, 2025 to eight Democratic governors running these programs, including Ferguson, Newsom, J.B. Pritzker (D-IL), Tim Walz (D-MN), Jared Polis (D-CO), Kathy Hochul (D-NY), Janet Mills (D-ME), and Tina Kotek (D-OR). Comer’s letters cited a Congressional Budget Office estimate that the federal government spent $16,200,000,000 nationally on Medicaid-funded emergency services for noncitizens during the Biden administration’s first three years.
HHS Press Secretary Emily Hilliard framed the federal position on the recovery effort plainly: “Protecting Medicaid from waste, fraud and abuse isn’t optional. It’s the law. Every dollar misspent on illegal healthcare spending is a dollar taken from vulnerable Americans.”
Washington lawmakers appropriated $20,000,000 this year assuming it would cover long-term care for 300 noncitizens. It will cover 173 — a per-enrollee cost, roughly $115,600, that reflects real long-term-care costs rather than obvious graft. The accountability story is the planning gap itself, arriving just as a federal law effective October 1, 2026 is projected to strip Medicaid coverage from roughly 14,000 Washington residents, including 1,500 in long-term care. Rep. Nicole Macri (D-Seattle) is asking Gov. Bob Ferguson’s (D-WA) office to find more money. DSHS Secretary Angela Ramirez and SEIU 775’s Adam Glickman both say the coming cut will make people sicker. And Washington is one of six Democratic-run states CMS found spending a combined $1,351,204,127 improperly on these programs — a pattern Chairman James Comer (R-KY) is now formally investigating in eight state capitals at once.
