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Commissioners, providers warn of gaps in WA Cares provider network, especially adult family homes
Summary
DSHS analytics show statewide coverage for many WA Cares services but key shortfalls for adult family homes and some residential services; commissioners and provider representatives flagged liability insurance costs, low perceived volume, and business-model concerns as barriers to enrollment.
The LTSS Trust Commission on June 24 received a detailed briefing on provider network adequacy for the WA Cares Fund and was told that several residential provider types — notably adult family homes, assisted living facilities and some nursing homes — remain short of DSHS targets.
Elena Tortellat, DSHS program analytics administrator, explained the methodology: the agency projected first-year beneficiary counts by county, set provider-to-beneficiary thresholds by service type, and compared those targets to currently registered providers. "Looking today, in King, we have 18 home care agencies registered and our target is 32," Tortellat said; she added Spokane has 11 registered against a target of 14.
Tortellat and other staff said many providers are in the application pipeline and that DSHS is conducting targeted outreach, Q&A sessions and issuing billing and provider guides to ease onboarding. Commissioners and local area agency representatives described continuing gaps in rural counties and structural hurdles for some provider types.
Commissioners also raised provider cost concerns. Kathleen McCall relayed a report from an in‑home care agency owner that adding WA Cares participation could mean roughly $4,000 in additional liability insurance costs, a barrier for small private‑pay operators. "That could be a big barrier for our private pay home care folks," a commissioner said; DSHS staff acknowledged the concern and said insurance requirements are DSHS contractor requirements and will be monitored for impact.
Area agencies on aging and local partners said they are exploring start‑up funding and creative models (including partial‑day or technology‑enabled adult‑day pilots) to help build capacity in underserved areas. The commission asked staff to return with a report on barriers to contracting for adult family homes, assisted living and nursing homes before the September meeting.
