Last month, I had the privilege of presenting to the Clallam Economic Development Council during the popular “Coffee with Colleen” session.  In that presentation, I gave participants a broad overview of how various insurance plans affect our District’s financial footing.  With changes in Federal policy back in July of 2025, soon to take effect in our state, and with the saturation of Medicare Advantage Plans that historically underpay, disallow coverage for a variety of visits, tests, and procedures, as well as deny services even after receiving prior authorization, many of our patients have expressed concern. With this message, I am sharing a few important resources to help you and your family navigate the often-complicated world of health insurance.

First, for those insured through Apple Health, our state’s Medicaid plan: Beginning January 1, 2027, individuals eligible for Apple Health for Adults will need to meet work requirements or have an exemption to stay on Apple Health (Medicaid). 

According to the Washington State Health Care Authority, you can meet work requirements by:

• Having at least $580 monthly household income
• Working a minimum of 80 hours per month
• Enrolling in an education program at least half-time
• Participating in a work program for a minimum of 80 hours per month
• Participating in community service for a minimum of 80 hours per month
• Having a combination of work, education, work program, or volunteering that totals at least 80 hours per month

If you do not meet one of these work requirement activities, you may be eligible for an exemption or current month’s exclusion. Please visit Home | Washington State Health Care Authority for more information and to understand these new policies and how they may affect your coverage.

Next,  I want to touch on Medicare Advantage (MA) plans. Of course, every patient needs to explore available options and decide on a plan that works best for them. At the same time, everyone who selects an MA plan should have information that helps them understand how this coverage affects the financial aspects of care at all Critical Access Hospitals, including here at FCH.

For context, rural hospitals typically serve fewer commercially insured patients, operate with payer mixes heavily concentrated in Medicare and Medicaid, and face higher levels of uncompensated care.  Like many rural communities across our state, MA has become a dominant source of Medicare coverage and outpaces traditional Medicare growth.

The most notable difference between MA and traditional Medicare plans is that we are experiencing higher rates of payment delays, restrictive utilization-management practices, unclear reimbursement policies, and claims issues, specifically, denial of claims, even when a patient’s care, test, or procedure received prior authorization. When this happens, FCH is faced with additional financial strains, places burdens on patients, and ultimately can lead to delayed care.

As I stated earlier, we understand that each patient must evaluate their health insurance coverage options, including having information that helps them understand aspects of MA plans that may not always be provided up front, leaving patients to find out what their plans won’t cover after the fact, and the details that explain the financial implications to their community hospital.

To learn more about the differences between Medicare plans, I am sharing a link to a document from the Washington State Hospital Association that clearly explains the items I mentioned here.  Also, if you have questions about the insurance plans we accept,  a bill, a claim denial for care you received at FCH, or if you need financial assistance, please visit the financial services pages on our website for more information.

Lastly, on a much lighter note, watch for information about our annual “Trick or Treat” event, brought to you by our Extended Care team and patients. This has become a favorite fall tradition and is a wonderful opportunity for our hospital family and community to come together for an evening of fun, laughter, and a little Halloween magic for the young and young at heart.

Wishing you and your families a healthy, happy, and beautiful autumn season!