Native American health care bill heads for governor’s desk

Measure had unanimous votes in both chambers

OLYMPIA — As the state legislative session begins to wind down to its April 28 conclusion, a Native American health care bill is headed to Gov. Jay Inslee’s desk with nary a negative vote.

The Washington Indian Health Improvement Act, co-sponsored by state Sen. Kevin Van De Wege of Sequim, would be established by SB 5415, which was approved 48-0 by the Senate on March 13 and 96-0 by the House on Thursday.

Van De Wege is one of three Democrats representing the 24th District, which covers Clallam and Jefferson counties and part of Grays Harbor County.

Indian Advisory Council

SB 5415 would establish a Governor’s Indian Advisory Council that would mandate adoption of a Native American health improvement plan every two years.

The bill aims to help a population that has high rates of mortality due to suicide, drug overdose, unintentional injury, obesity and medical conditions such as heart disease, diabetes and hypertension, according to the legislation (

With Inslee’s signature, it would create the Indian Health Improvement Reinvestment Account, proceeds of which would be spent on projects, programs and activities identified in the advisory plan.

The account would be funded by savings realized by the state under which tribes receive a higher reimbursement rate on medical services than the state would get with regular Medicaid, 24th District state Rep. Steve Tharinger of Port Townsend said Friday.

In 2016, the federal Centers for Medicare and Medicaid Services allowed medical services provided to a Native American Medicaid enrollee to be reimbursed at the 100 percent federal match level through the tribal clinic if the clinic requests the service from a non-Indian Health Service or non-tribal health care provider who also is a Medicaid provider.

The service would be set up through a care coordination agreement between the tribal clinic and the non-tribal provider.

“The new state savings is reflected as the difference between the 100 percent federal match actually received for the service and the match that the state would have otherwise received for the service,” according to the House bill analysis (

“The difference between the two goes into a fund for better outcomes and better services in Indian Country,” said Tharinger, a member of the House Health Care & Wellness Committee.

Similar legislation was considered last year but was too broad, said Tharinger, also a member of the governor’s Indian Health Advisory Council.

“His input was key in creating legislation that passed both chambers unanimously, as well as Sen. [John] McCoy, who is a Tulalip tribal member,” said Vickie Lowe of Sequim, executive director of the American Indian Health Commission (AIHC) and a Jamestown S’Klallam Tribe descendant.

The advisory council will oversee the tribal reinvestment account.

“When it gets up and going, we figure $15 million to $30 million a year will go back into the health care delivery system in Washington state,” Lowe said.

Savings are realized by the Native American health care clinics contracting with specialty providers and billing the state for the 100 percent federal medical assistance percentage paid by the federal government, she said.

“We can pay more than the Medicaid is paying,” Lowe said.

The legislation will enable the clinics, many of which see non-Native American patients, to build more facilities, pay more providers “and can be more innovative and address issues in a way that we don’t get to normally, so we’re very excited about it,” Lowe said.

Van De Wege said the five tribes in Clallam County among the state’s 29 tribes are at a disadvantage due to their location.

“Anything we can do to make the tribes healthier helps them and helps the state long-term,” he said.

State Rep. Mike Chapman of Port Angeles, also a 24th District lawmaker, noted the unanimous votes in both chambers.

“There’s no controversy there,” he said.

“It brings parity to Native American folks and brings up the reimbursement rate for the health care.”

The three 24th District legislators said Friday they expect the House and Senate to agree on a 2019-21 budget by April 28.

Lawmakers continue to negotiate on legislation to allow school districts to raise additional funds through levies for hard-pressed extracurricular programs and activities, Van De Wege said, adding in an email that it will be “a primary focus” in the final days of the session.

Chapman said he would vote in favor giving school districts the authority to raise the levy cap.

“I’m all for giving local school districts more authority and allowing local voters to decide what they want to fund,” he said, adding that what it comes down to is “local control.”


Senior Staff Writer Paul Gottlieb can be reached at 360-452-2345, ext. 55650, or at

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