WashingtonSB 52912025-2026 Regular SessionSenateWALLET

Implementing the recommendations of the long-term services and supports trust commission.

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Bill Overview

Analyzed Economic Effects

29 provisions identified: 17 benefits, 5 costs, 7 mixed.

Care insurance can protect Medicaid assets

Beginning May 1, 2026, qualifying long-term care policies can protect some or all assets in a Medicaid eligibility decision. This includes policies covered by the new supplemental insurance framework and the specified existing insurance laws. Policyholders must meet Washington partnership criteria and other applicable policy terms. Federal Centers for Medicare and Medicaid Services approval is required; the law does not specify the amount protected.

Older workers qualify with fewer years

People born before January 1, 1968, can qualify after at least one year of required premium payments. They receive one-tenth of the maximum benefit units for each premium year through this shorter path. Three qualifying premium years within the six years before applying can provide the maximum benefit instead. Applicants still must meet the program's care-need requirements.

Workers qualify for long-term care benefits

Workers qualify through 10 premium years, which need not be consecutive, or three years within the six years before applying. Each counted year requires at least 500 hours of work. Beginning July 1, 2026, Washington applicants must need help with at least three daily activities for 90 days or more. Beginning July 1, 2030, out-of-state applicants need substantial help with two daily activities for at least 90 days, or substantial supervision for severe cognitive impairment. Exempt workers must first end their exemption; canceled out-of-state elective coverage bars qualification. The state must decide eligibility within 45 days after receiving a request to use benefits.

Care insurance sellers face stronger oversight

Beginning May 1, 2026, supplemental care insurance sellers need proper licenses and long-term care training, including an approved one-hour course. Insurers must verify training and keep records; required education generally cannot be issuer-specific sales training. Sellers must assess buyers' best interests, including affordability, financial circumstances, care goals, and existing coverage; accelerated-benefit life policies are exempt. The commissioner must set rules for clear disclosures, adequate premiums, benefit-to-premium ratios, large rate increases, privacy, claim reviews, and prompt payments. Violating insurers or sellers face fines of up to three times commissions for each involved policy or $10,000, whichever is greater.

Care policyholders gain premium increase safeguards

Supplemental care policies must provide benefit-reduction or value-preserving options when higher premiums become unaffordable or unwanted. Beginning May 1, 2026, insurers generally must offer an option that preserves some benefits after coverage ends. Declining that option still requires a backup benefit if coverage lapses after a substantial premium increase. Most group plans must offer the option to each proposed certificate holder, rather than only the group buyer. Beginning May 1, 2026, the insurance commissioner also sets minimum inflation-protection standards and rules defining lapse benefits and triggers.

Care policyholders gain stronger coverage protections

Insurers cannot end supplemental care coverage because a policyholder ages or their mental or physical health worsens. Replacing coverage within the same company cannot restart waiting periods, except for voluntarily increased benefits. Policies cannot cover only skilled nursing or give much more coverage to skilled facilities than lower-level care. They generally cannot require prior hospitalization or institutional care; listed recovery and premium-waiver benefits have exceptions, and specified recovery limits must clearly state required days. Generally, preexisting conditions are limited to medical advice or treatment within six months before coverage, and related exclusions to losses beginning within six months afterward. Named-condition exclusions cannot extend beyond the waiting period; specified group exceptions and commissioner-approved extensions apply.

Private coverage protects existing care arrangements

Supplemental policies must let people keep care settings and providers used under the Trust, including suitable family providers. Insurers can require changes only when substantial evidence shows the current care cannot meet health or safety needs. Required changes can take effect 90 days after the transition from public benefits, and policyholders can seek independent review. Insurers must request written consent before sharing a purchase notice and basic identifying information with the state care department. This sharing cannot include health information or claims data.

Care benefits keep pace with inflation

The Trust pays for approved care, including qualifying long-term care in nursing homes. Its lifetime maximum is 365 benefit units, each with a base value of up to $100 for approved care on a specific date. Units adjust annually using Seattle-area CPI-W inflation over the 12 months before September 1; changes start the following January 1. Partial units and combining units across days are allowed within the lifetime cap. Beginning January 1, 2026, the law also repeals the former council benefit-adjustment provision; the supplied text identifies no separate dollar change from that repeal.

Family caregivers can receive care payments

Qualified relatives can receive payment for approved personal care through an individual-provider arrangement or a licensed home care agency. Another payment option requires a commission recommendation and state approval. Relatives must meet service-specific requirements, but not the general requirements for other providers paid by the state. Beginning January 1, 2026, paid qualified relatives count as personal aides when helping adults with functional disabilities at home. That date also brings home-care regulation exemptions for consumer-directed employers and state-contracted financial agencies serving only clients of qualified family caregivers.

Missed payments end out-of-state care coverage

Beginning July 1, 2026, the state must cancel elective Trust coverage for out-of-state participants who miss required payments or reports. The Employment Security Department must send written notice. Cancellation takes effect no later than 30 days after that notice and can end access to Trust benefits.

Union workers lose premium payment exception

The law removes the exception for union agreements that existed on October 19, 2017. Those agreements no longer delay program duties until they are reopened, renegotiated, or expire. General payroll deduction and premium collection rules apply to covered workers and employers. The program premium is 0.58% of wages.

Private care policies face payment limits

Supplemental long-term care policies cannot impose a benefit waiting period longer than 12 months; time as an eligible Trust beneficiary counts. Insurers cannot require a functional assessment to start or end that wait, though claim approval can require one. Deductibles cannot exceed the public program's maximum dollar benefit, including inflation adjustments; insurers can set lower deductibles. Insurers must accept state notice of exhausted benefits as proof the deductible is met; for people born before 1968, the state reports benefits paid toward it instead. A policy with both a deductible and waiting period can require both to be met before the wait is considered satisfied.

Insured workers can rejoin public coverage

Workers with approved private long-term care insurance exemptions can rejoin the Trust by notifying the state before July 1, 2028. Premiums begin when they notify the Employment Security Department. No premiums are owed for the earlier exempt period. An exempt year counts toward qualification only if premiums covered part of that year and the worker met the 500-hour minimum.

Moving workers keep coverage with obligations

Beginning July 1, 2026, workers can elect continued coverage after moving outside Washington, but cannot later withdraw. They need three Washington premium years with at least 500 work hours each and must notify the state within one year of establishing an out-of-state primary home. Participants must report wages and pay premiums, even after age 67; nonpayment or nonreporting can cancel coverage. Out-of-state care providers must meet state care and administration standards and hold appropriate local credentials. The law removes specified unpaid-premium collection and additional-premium powers, but does not forgive unpaid premiums.

Some workers can skip care premiums

Workers can apply for premium exemptions if they are veterans with a VA service-connected disability rating of at least 70%. Other eligible groups include active-duty military spouses or registered partners, workers with permanent primary homes outside Washington, and active-duty members with off-duty civilian jobs. Exempt workers cannot receive Trust benefits while their exemptions remain active. Nonveteran exemptions end within 90 days after military discharge or separation, relationship dissolution, or a move into Washington, as applicable. Workers must notify the state and employer within 90 days of the ending event and resume premiums; late payments accrue 1% interest per month or part of a month.

Temporary visa workers choose care coverage

Employees holding temporary-worker nonimmigrant visas do not pay Trust premiums or receive its benefits unless they opt in. They join by telling their employer they want to participate. Joining brings both premium duties and access to the program's qualification paths. Workers become subject to the program when they become permanent residents or citizens employed in Washington.

Care insurance buyers gain sales safeguards

Beginning May 1, 2026, sellers and issuers of supplemental care insurance cannot use unfair competition or deceptive practices. People and businesses cannot sell or transfer applicants' information used to judge whether coverage suits them. The insurance commissioner must create a consumer guide and expand education, focusing on middle-income buyers. Education must explain coverage gaps, out-of-pocket costs, waiting-period and premium tradeoffs, and budgeting Trust benefits. The commissioner must expand the statewide health insurance advice program for this purpose only if federal law allows it.

Care insurance buyers get clearer information

Buyers must receive coverage information explaining public benefit interactions, possible premium increases, affordability options, retirement premiums, premium waivers, and exemption eligibility. In-person sellers provide it before applications; direct-response sellers provide it with applications, with alternative enrollment materials allowed for specified groups. Approved contracts or certificates must arrive within 30 days of approval. Buyers can return coverage for any reason within 30 days of delivery for a premium refund, except specified employer or labor-group certificates. Issuers must provide a refund or denial within 30 days after receiving the return. While care payments draw from a life insurance death benefit, monthly reports must show payments, policy changes, and remaining benefits.

Care insurers face claim decision deadline

Beginning May 1, 2026, insurers must pay clean supplemental care claims or explain denials within 30 business days. The clock starts after the insurer receives all requested additional information. Written notices must give specific reasons for full or partial denials.

Insurers face approval and disclosure rules

Insurers must get state approval before using supplemental care policy and application forms, rates, or rate changes. Agents or administrators can issue policies in the field only under the insurer's underwriting authority and guidelines. Their pay cannot depend on how many policies they issue. Beginning May 1, 2026, partnership policy rules must include the new supplemental insurance requirements. Partnership insurers must show procedures for consumer notices, policy records, coverage explanations, and annual reports with standard data.

Policyholders get stronger claim challenge protections

Beginning May 1, 2026, insurers face limits on canceling supplemental care coverage or denying otherwise valid claims for application misstatements. In the first six months, the misstatement must matter to accepting coverage. From six months to less than two years, it must also concern the condition behind the claim. After two years, challenges require knowing, intentional misstatements about relevant health facts; insurers cannot recover benefits paid under a canceled policy. These rules cover life policies that advance care benefits, but not their remaining death benefits.

Clearer care coverage and private coordination

The state must define which goods and services the long-term care Trust covers and excludes. These rules must aim to make the most of available public and private benefits. When qualified people apply, the state must ask about supplemental insurance and request written consent and insurer contact details. With both, the state must notify the insurer and may share basic identifying details. It cannot share health information or claims data.

Supplemental insurance must extend care coverage

Beginning May 1, 2026, new Washington supplemental long-term care policies generally must cover at least 12 consecutive months after Trust benefits run out. The rules also cover insurance advertised, marketed, or offered as supplemental long-term care coverage. Life insurance-funded coverage is allowed when it meets the law's definition and benefit requirements. Medicare supplement rules do not apply to this coverage. This supplemental coverage falls outside Washington's existing long-term care insurance chapter and under the new framework.

Limited pilot tests care benefit access

The law authorizes a care benefits pilot only from January 1 through June 30, 2026, with no more than 500 participants. Participants may be offered Trust benefit units. The social services, employment security, and health care agencies can test eligibility decisions and provider payments. They must update and consider Trust Commission recommendations and report results and operating challenges to the commission.

Program receipts support the care Trust

Employer and out-of-state participant receipts go into the long-term care Trust account. The account also receives collected late premiums, penalties, and interest. Beginning January 1, 2026, qualifying shared savings from a federal Medicare and Medicaid agency waiver must also go into the account. This savings rule applies only when Washington obtains a waiver that produces shared savings from long-term care spending. The law states no deposit amount or direct household payment.

Group care insurance faces eligibility checks

Associations in the specified category need at least 100 members and one year of active existence to offer group coverage. They must serve purposes beyond buying insurance and meet membership and governance requirements. Associations or insurers must file evidence before advertising, marketing, or offering coverage. Unlisted groups need commissioner findings of public interest, cost savings, and benefits reasonable compared with premiums. Certain out-of-state group policies cannot be offered to Washington residents without approval from Washington or a state with substantially similar rules.

Delinquent employers face stronger debt collection

The state can collect unpaid care premiums, interest, and penalties through liens, property seizure and sale, withholding orders, and lawsuits. Property seizure can follow when an assessment remains unpaid 10 days after delivery or mailing. The state can assess immediately when insolvency or another threat makes delay risk losing payment. Courts can stop a delinquent employer from doing business or employing people in Washington. Employers can avoid that order by paying the debt or providing the required bond.

Employers must report and retain records

Covered employers must submit reports, supply information, collect care premiums, and send them to the Employment Security Department. Temporary help companies count as employers for these duties. Employers must keep employment records at their business for six years and allow state inspection. Records remain confidential, with specified access for public employees, parties presenting a case, and people the employer authorizes.

Employers face premium penalties and relief

Willful missed premium reports cost employers $75 for a second failure, $150 for a third, and $250 for each later failure. Willful failure to send premiums adds a penalty equal to premiums and interest due; unpaid premiums accrue 1% interest per month or partial month until paid. Reporting and payment penalties require knowing, intentional failure—not accidents or genuine disputes—and the state must first seek resolution through conference and conciliation. Interest can be waived when an employer supplied adequate information but the state failed to act, advised no liability, or could not decide. The commissioner can reduce debts when full collection is unfair, or write off amounts with no cost-effective collection option.

Sponsors & Cosponsors

Sponsor

Steve Conway
Democratic • Senate

Cosponsors

Annette Cleveland
Democratic • Senate
Claire Wilson
Democratic • Senate
Derek Stanford
Democratic • Senate
Javier Valdez
Democratic • Senate
Noel Frame
Democratic • Senate
Rebecca Saldaña
Democratic • Senate
T'wina Nobles
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 151 • No: 40

Senate vote • 4/22/2025

Final Passage as Amended by the House

Yes: 35 • No: 13

House vote • 4/11/2025