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Washington has 27 community health centers across 489 sites serving 1,275,767 patients — the #4 FQHC state by patients outside California and Texas. As an expansion state, Medicaid anchors the safety net, and H.R. 1 work requirements plus the December 2026 funding cliff are the key risks.
Washington is a Medicaid-expansion state where Apple Health covers roughly 1.9 million people, and its safety net leans on large multi-site community health centers — Sea Mar alone serves ~298,000 patients across 18 Western Washington counties — staffed substantially by nurse practitioners who hold full, independent practice authority. The state went further than most by funding Apple Health Expansion to cover undocumented adults with state-only dollars, but the program is capped and now closed to new enrollment, and 2026 brings a triple squeeze: H.R.1 Medicaid cuts, the December 2026 federal Community Health Center Fund cliff, and a state budget deficit. Most acutely, Gov. Ferguson's proposed pharmacy carve-out from managed care would strip 340B savings from CHCs — a $100M+ annual hit the Washington Association for Community Health warns could force service cuts and layoffs.
Patient-weighted across the 27 centers with UDS 2024 data.
Washington grants nurse practitioners full practice authority: under RCW 18.79 and WAC 246-840-300, ARNPs assess, diagnose, order and interpret tests, and prescribe (including controlled substances) independently, with no required collaborative or supervisory agreement with a physician.
Medicaid community-engagement (work) requirements under CMS-2454-IFC (80 hrs/month, full implementation Jan 1, 2027) plus expiry of the enhanced ACA premium tax credits (end of 2025) threaten Washington's expansion population and FQHC Medicaid revenue.
5 primary-sourced findings on Washington FQHC policy and financing.
Gov. Ferguson's proposed budget would move the Medicaid pharmacy benefit out of managed care, eliminating community health centers' 340B Drug Pricing Program savings. The Washington Association for Community Health says centers would lose $100M+ annually while the state saves only about $7.5M; Clark County centers and Sea Mar (~298,000 patients across 18 counties) warn of likely service cuts and future layoffs.
The Columbian / Washington Association for Community HealthUnder H.R.1, non-pregnant Apple Health adults 19-64 must verify 80 hours/month of work or community engagement starting December 2026. HCA's Medicaid director warns ~620,000 Washington adults risk losing coverage chiefly due to administrative burden, even though most already work; Washington's eligibility-automation system won't be ready until June 2027, so HCA is seeking an extension (state qualifies for delay to December 2028).
Washington State Health Care AuthorityThe Consolidated Appropriations Act signed in February 2026 extended the $4.6B Community Health Center Fund only through December 2026, again denying the multi-year reauthorization health centers seek. Seattle's ICHS and other WA FQHCs rely on this base grant funding, and the short-term-only horizon — stacked on H.R.1 Medicaid cuts and state budget pressure — leaves them unable to make long-range staffing or capital commitments.
International Community Health Services (ICHS) / NACHCWashington's state-funded Apple Health Expansion, which began covering undocumented adults in July 2024 with a ~13,000-person enrollment cap that filled within days, remains closed to new enrollment as of late 2025. The 2025-27 budget continued the program but only at the existing ~$150M funding level, and HCA says it will not reopen enrollment while H.R.1's federal Medicaid changes take effect; current enrollees keep coverage.
Washington State Health Care AuthorityIn its statement on H.R.1's passage, the Washington Association for Community Health projected that 250,000+ Washingtonians will lose Medicaid coverage and warned the law will strain community health centers, noting it also eliminates federal authorization for AHEC (Area Health Education Center) workforce funding. WACH says it remains focused on keeping centers able to deliver primary care to everyone.
Washington Association for Community HealthBy patients (HRSA UDS 2024). Tap for the full profile.
| Organization | Patients | Sites | Uninsured | Revenue (990) | District |
|---|---|---|---|---|---|
| Sea Mar Community Health Centers Seattle | 219,800 | 83 | 14.91% | $476M | WA-07 |
| Yakima Valley Farm Workers Clinic Toppenish | 202,651 | 41 | 9.97% | $349M | WA-04 |
| Community Health Association of Spokane Spokane | 122,517 | 33 | 10.92% | $267M | WA-05 |
| Healthpoint Renton | 92,071 | 23 | 15.46% | $182M | WA-09 |
| Community Health Center of Snohomish County Everett | 76,028 | 15 | 11.34% | $82M | WA-02 |
| Neighborcare Health Seattle | 59,715 | 32 | 20.82% | $98M | WA-09 |
| Community Health Care Tacoma | 54,543 | 14 | 12.18% | $85M | WA-10 |
| Peninsula Community Health Services Bremerton | 50,167 | 44 | 5.84% | $56M | WA-06 |
| Columbia Valley Community Health Wenatchee | 42,393 | 25 | 18.02% | $61M | WA-08 |
| Columbia Basin Health Association Othello | 42,218 | 6 | 23.27% | $105M | WA-04 |
| District | Representative | Sites |
|---|---|---|
| WA-04 | Dan Newhouse | 96 |
| WA-06 | Emily Randall | 65 |
| WA-09 | Adam Smith | 63 |
| WA-07 | Pramila Jayapal | 60 |
| WA-05 | Michael Baumgartner | 51 |
| WA-03 | Marie Gluesenkamp Perez | 40 |
Washington ranks #4 by FQHC patients and #19 by organization count among the 57 national-breadth states/territories (excludes California and Texas, which have dedicated dashboards). All 27 centers depend on the federal Community Health Center Fund, authorized only through December 31, 2026.
FQHC data from the HRSA bulk-sites file + UDS 2024 + IRS 990. State policy profile via NACHC/KFF/AANP. Intelligence items cite primary sources. Federal items apply to all states; state items are Washington-only. Updated 2026-06-03.