Harborview warns of deep Medicaid funding losses, urges county support for dedicated infusion center

Harborview Medical Center leaders and union representatives told the King County Housing, Health and Human Services Committee that looming federal changes to Medicaid reimbursement threaten the hospital’s finances and patient access and asked the council to preserve flexibility in county funding to prioritize frontline care.

"We need an infusion clinic," Andrew, a Harborview nurse, told the committee, describing repeated relocations of the makeshift infusion area and a ramp-up in patients needing IV treatments for autoimmune disease, iron deficiency and newly approved Alzheimer’s therapies. He said the unit had moved five times in seven years and that December saw a record 760 visits in a month — roughly triple volumes from two years earlier.

Lindsay Grad, legislative director for SEIU Healthcare 1199NW, urged the council to allow operating resources to be redistributed quickly to prevent cuts to workforce and frontline services. Grad said the union supports a modest language change in last year’s budget to ensure operating dollars reach patient care before crisis-driven cuts take effect.

Harborview management outlined three near-term capital priorities: infrastructure repairs in the center tower, a consolidated infusion clinic with co‑located specialty clinics, and a parking facility to replace spaces that will be lost during tower construction. Management said it has raised about $8 million toward the infusion project and described a current plan to expand from roughly five to seven chairs to more than 16 chairs in a new space at the 9th and Jefferson building. Management also reported a projected cumulative reimbursement shortfall linked to federal policy changes and directed‑payment reductions that it estimated at about $700 million by 2031; panelists framed that figure as both forward‑looking and already prompting operational changes.

Councilmembers pressed staff for a breakdown of the $700 million estimate and asked about timing. Management said the buildout is likely to take several years (longer than the 18 months once envisioned), but that careful planning could reduce moves: if the timing aligned, staff currently working in the ad‑hoc area would have a single move into the new space. The management team said bond planning and tower construction will force multiple relocations across services and emphasized that early coordination — and a possible reprioritization of tax‑authority allocations — is needed to avoid disruption.

The committee did not take any formal vote on Harborview items; members asked county staff and Harborview to provide a clearer accounting of how the '15¢' hospital tax authority is being allocated between capital and operations and to circulate proposed budget-language edits and a timeline for the infusion project. The council also signaled interest in exploring limited flexibility in the Medicaid reserve fund to allow proactive use of funds to prevent service reductions.

The committee will follow up as management, the Harborview board and the executive’s office refine proposals and return with more detailed budget language and project timelines.