Committee warns HR 1 could shrink Medicaid coverage and cost Washington billions

Washington State Senate Ways and Means Committee members heard detailed warnings on October 16 about the reach and fiscal consequences of HR 1 for the state’s Medicaid program.

Health Care Authority Director Ryan Moran told the committee HCA and partner agencies face large technology upgrades and staffing needs to implement multiple new eligibility and verification requirements “to try to preserve and mitigate as much coverage impact to participants as possible.” He said agencies are simultaneously preparing for CMS guidance expected in mid‑2026 and must plan now for phased implementation through 2029.

The nut of the change, HCA’s eligibility staff said, centers on two provisions that will most affect expansion adults who gained coverage after the Affordable Care Act: a new definition of who counts as a fully federally funded “qualified alien” effective October 1, 2026, and a new community‑engagement work requirement. Trinity Wilson, Assistant Director for Medicaid Eligibility, estimated the qualified‑alien change could affect “as many as 30,000 individuals” in Washington and said roughly 620,000 adults are currently…