By Gina Maffei / For The Herald
More than 16,000 Washingtonians live with end-stage renal disease (ESRD). For them, kidney dialysis isn’t just important care: it is life-sustaining treatment.
Three times a week, every week in one of 112 kidney dialysis facilities across the state, patients spend hours connected to a machine that does what their kidneys can no longer do. Without it, survival simply isn’t possible. And while some are fortunate to receive a transplant, there is a shortage of available organs, and many patients are not candidates. For them dialysis is the only treatment course available.
That is why the state Health Care Authority’s recent decision to slash Medicaid dialysis reimbursement rates by 30 percent, effective January 2026, is so alarming. The cut would undo the rate increase that statelawmakers approved in 2023 and implemented in January 2024. That increase was the first after more than 16 years. While we understand the state is currently in a difficult budget situation, we are concerned that pulling back this much-needed financial support now jeopardizes the ability of kidney dialysis clinics to stay open and keep providing life-sustaining care to Washingtonians with ESRD.
The reimbursement environment for kidney dialysis is unique in the health care industry in that, according to federal law, almost all people diagnosed with ESRD are eligible for Medicare after four months, not just those over the age of 65. However, Medicare only pays for approximately 80 percent of health care costs, leaving the remainder to be paid by the patient. This makes Medicaid particularly critical for renal disease patients who no longer have access to commercial coverage because of the difficulty of maintaining steady employment while receiving kidney dialysis, which can take three to five hours for one session.
Unlike most other health care providers that may enjoy a more proportional payer mix, kidney dialysis facilities operate with about 90 percent of our patients on Medicare and/or Medicaid; both of which reimburse under the total cost of care. Unfortunately, the recent action by the state HCA to cut the kidney dialysis Medicaid rate by 30 percent will have negative consequences for the viability of some dialysis clinics, which in turn will affect access to dialysis services across the state.
The human cost of patients not being able to access dialysis shows up in hospital emergency rooms. If dialysis clinics are forced to close and patients no longer have convenient access to care, they are more likely to miss treatments or seek help at hospitals. A missed dialysis treatment can raise mortality by as much as 30 percent, and it increases pressure on already overburdened emergency departments. Cutting dialysis reimbursement does not save money. It shifts costs and worsens outcomes.
Lawmakers acted in 2023 to increase Medicaid dialysis rates because they recognized the danger of underfunding kidney dialysis care. The Health Care Authority’s recent decision to reverse that action and cut dialysis reimbursement will put patients’ lives in danger, add strain on hospital emergency departments and overall state health care costs. That is why we are urging the governor and the HCA to rescind the cut before it takes effect next year. There is still time to protect kidney dialysis access for the state and ensure that Washingtonians will continue receiving life-sustaining care in their communities.
Gina Maffei is the administrative director of the Northwest Kidney Council, a coalition representing providers, patients and advocates promoting safety and access to quality kidney care across the Pacific Northwest.
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