Evan Klein, special assistant for legislative and policy affairs at the Health Care Authority, told the committee that Washington submitted its application to CMS on the day of the committee meeting and that the application is publicly posted.

Klein described the federal program created by HR 1 as a $50 billion Rural Health Transformation fund. States were asked to apply; each approved state receives a base allocation (Klein said the formula guarantees at least $100 million if all states apply) and additional funds are distributed based on rurality and technical scoring. Klein cautioned that Washington is unlikely to receive the full $200 million per year requested in the template and that final award amounts will be announced by CMS after application review.

Washington’s application includes six initiatives: 1) support and payment reform for rural hospitals and critical services (about 30% of proposed funds); 2) prevention and community care including mobile supports and EMS; 3) a tribal set‑aside (~10%); 4) technology and data investments (telehealth, Project ECHO, cyber and AI tools); 5) workforce development (WAMI, residencies, nursing education and 'grow your own' programs); and 6) behavioral‑health expansion (mobile crisis, certified community behavioral health models, school‑based services and opioid treatment in rural areas).

Klein said the application reflected robust stakeholder engagement — including an RFI that produced more than 310 written submissions, multiple webinars and tribal consultation — and proposed an advisory committee to guide deployment of funds during the five‑year program. The agencies said they will return to the legislature to align any federal awards with state appropriation decisions for implementation.

Klein noted CMS will approve or deny applications before the end of the calendar year and that timelines could be affected by the federal government shutdown, though CMS had recalled staff to process submissions.

Committee members asked about clinical priorities such as palliative care, and HCA staff said palliative services were considered within prevention/community‑care and workforce initiatives rather than as a standalone fund line.