DSHS outlines long-term care priorities, workforce strains and federal compliance needs

Bea Rector, assistant secretary of the Aging and Long Term Support Administration at the Washington Department of Social and Health Services, told the House Health Care & Wellness Committee on Jan. 17 that the administration is focused on expanding home- and community-based supports, meeting new federal requirements, and preparing to implement the WA Cares long-term care benefits program.

Rector said DSHS serves nearly 3,000,000 Washingtonians and manages a roughly $10.4 billion biennial budget and about 27,100 employees; she said 90% of those dollars are pass-through payments that pay for direct services. "People want easy access to services that are affordable. People want choice and autonomy in where they live," Rector said.

Why it matters: Washington’s population is aging and the share of working-age residents is shrinking, Rector said, producing both a higher demand for long-term services and pressure on the direct care workforce. The administration projects substantial growth in the population age 85 and older over the next 20 years and described an ongoing direct care worker shortage.

Rector outlined current services and scale: DSHS provides Medicaid-funded long-term care supports to more than 70,000 individuals each month and helps roughly 400 people per month transition from acute hospitals into community-based care. She said adult family homes and other residential settings now account for a growing share of placements, while approximately 10% of Medicaid long-term care recipients are in skilled nursing facilities.

Rector emphasized family caregivers’ role: "About 85% of all services are provided by unpaid family caregivers," she said, and highlighted programs that support them, including respite, training and options to become paid providers. She said DSHS measures improved caregiver outcomes among participants in those programs.

Federal compliance and legal-assistance request: Rector said Centers for Medicare & Medicaid Services and the Administration for Community Living issued final rules in 2024 on the home-and-community-based settings requirements and that Washington must align state protections for Medicaid residents who live in adult family homes, assisted living and enhanced services facilities. She said the administration is seeking budget authority to provide legal assistance for Medicaid residents contesting involuntary discharges; that request was described as being submitted as part of the Office of Administrative Hearings' budget in the presentation.

Committee clarification on discharge processes: Committee members asked whether residents in skilled nursing facilities are covered by the same eviction protections. Rector clarified that skilled nursing facilities are considered institutional settings and are not covered by the HCBS comparable‑protections requirement; instead, federal and state rules provide an administrative appeals process for discharges from skilled nursing facilities. The legal assistance funding request, she said, would apply to Medicaid residents in residential (non-institutional) settings who are involuntarily discharged and seek to contest the discharge.

Workforce and WA Cares: Rector described workforce development partnerships (including high-school training pathways for certified home care aides), incentives and wage efforts to retain direct care workers. She also reviewed WA Cares, the state long-term care insurance program: workers began contributions in July 2023, benefits vest and will be available beginning July 2026, and the program’s lifetime benefit was presented as $36,500 indexed to inflation.

Rector closed by urging legislative attention to housing affordability and supports that let people remain in community settings rather than institutional care. She said DSHS is pursuing continued rebalancing strategies that, historically, reduced the share of Medicaid long‑term care delivered in nursing facilities from about 43% in 1996 to about 10% today.