State health officials outline impacts of federal Medicaid cuts

A collection of state health officials said Thursday that cuts to federal Medicaid and food assistance programs’ funding, adopted this summer, have left them looking for ways to minimize the impacts on Washington residents, though they warned the changes could “ripple across the health care system.”

“I’m sad, because it doesn’t have to be this way,” Charissa Fotinos, Medicaid director for the Washington Healthcare Authority, said during a Senate committee hearing on Thursday. “And I’m angry, because it doesn’t have to be this way.”

The meeting of the Senate Ways and Means Committee comes as state officials look to implement provisions included in the One Big Beautiful Bill Act, which includes, among other things, more than $1 trillion in cuts to Medicaid over the next decade by imposing new work requirements and other reforms to the program.

Republican lawmakers have said the changes to Medicaid are needed to reduce waste, fraud and abuse in social service programs.

The governor’s office has previously estimated that across the state, at least 250,000 residents will lose Medicaid coverage, while around 150,000 people will be priced out of the state’s health care exchange.

While Washington reported the lowest uninsured rate in the country in 2024 at 4.8%, the governor’s office has warned that the funding cuts could “balloon that number into double digits.”

The cuts to Medicaid, Fotinos said Thursday, are part of the changes made to the “three-legged stool” that shapes the state’s Affordable Care Act marketplace. Coupled with the potential expiration of enhanced premium tax credits, which could result in 80,000 people being priced out of the market, and a Marketplace Integrity and Affordability rule adopted in June, Fotinos said the changes could reduce enrollment in qualified health plans in Washington by up to 50%.

“There’s already likely an increase of 15% of premiums above the baseline, and these effects will ripple across the healthcare system, as people choose to either forgo care and become uninsured and then seek care when they have to in an emergency department or a hospital,” Fotinos said. “Putting more pressure on the hospitals for uncompensated care.”

Among those concerned with the decreased Medicaid funding is Kishanee Haththotuwegama, a third -year medical student at the Washington State University College of Medicine in Spokane, who said the cuts could increase the cost of care in the future as treatment is delayed.

Ahead of Thursday’s hearing, Haththotuwegama recalled the story of a man she encountered while conducting outreach work to homeless people this summer.

The man, who she identified as “Joe,” had recently been released from a hospital in north Spokane after undergoing a hernia surgery. Following the surgery, Joe had walked 5 miles to a shelter to sleep, but was discharged from the shelter the following day when the shelter closed.

According to Haththotuwegama, Joe’s surgery, medication and post-operation care were paid for through Medicaid.

“He could schedule this surgery before it became life-threatening,” Haththotuwegama said. “Without coverage, he would have had to wait until the hernia had twisted, cutting off the blood supply to his intestines. This is a surgical emergency we call strangulation.”

By law, Haththotuwegama said, hospitals are required to treat this type of emergency care, a procedure that would have cost $11,535 out of pocket without Medicaid.

“Since he had no way to pay, the hospital would have had to eat that cost, or pass it on to the rest of us,” Haththotuwegama said.

The potential for patients to forgo needed care is something Fotinos said she’s seen before. During her testimony, she recalled two patients: a 13-year-old homeless girl in Seattle with a broken arm and an elderly woman who had broken her hip in a fall. In both cases, Fotinos said she was unable to find someone who could treat their injuries, exacerbating them.

“I highlight those because I’ve been there, I’ve done this, and I’m sad that we have to think about going back there,” Fotinos said. “Everyone at our agency … is trying to minimize and work our tails off, to figure out how we navigate all of this and minimize the impact to the people of Washington.”