Earlier this week, Governor Inslee released his proposal for reopening the Washington state economy. (here) The plan is conservative and prioritizes health considerations over a rapid return to normalcy.

The governor lists five requirements:

• More testing.
• Contact identification capabilities.
• Personal protection for everyone who needs it.
• Adequate capacity in the state’s health care system.
• A vaccine.

The report goes on to say that the number one priority is preventing another outbreak by following these guidelines:

• The prohibition of most large gathering.
• Telework and distance learning.
• Physical distancing of six feet.
• Industries will open at various rates based on state guidance.
• Restrictions will go back in place if another outbreak occurs.

The plan concludes with specifics on three areas:

• Protect the health and safety of Washingtonians.
• Facilitate a safe start and transition to economic recovery.
• Support all people and communities.

It is the third area where the federal government became involved this week. Last month, Washington state officials requested a Medicaid waiver, called an 1115 waiver, from the Centers for Medicare and Medicaid Services. (here) The waiver was approved this week.

Basically, the waiver allows Washington state to alter and expand its Medicaid program to divert Medicaid funds to fight the COVID-19 crisis:

• Services can be targeted to specific areas, not necessarily state-wide.
• Patients requiring long term care can self-attest to income level.
• The state can establish alternate medical settings such as hotels, schools, and churches.
• Provider payments can increase by 50 percent.
• Nursing homes can receive retainer payments for up to 30 days.
• Allows the state to expand federal poverty level criteria and recipients may self-attest to income level.

The COVID-19 crisis has caused a total upheaval of American society. Unbelievable medical and economic hardships occur on a daily basis. It is no surprise that once again the Medicaid entitlement has been tapped to finance the battle against the virus.

Medicaid began in 1965 as a health insurance safety net for low-income families with children, some long term care, and some disabled care. Over the past 50 years, the entitlement has expanded dramatically and is now one of the top three budget items for every state. (here) While expanding Medicaid further during the COVID-19 may make sense in the short term, the ultimate goal should be meaningful reform that prioritizes the most vulnerable Americans and makes the entitlement financially sustainable. (here)