Washington's Insurance Chief Proposes a Primary Care Fund. Her Bill Names DPC.

Washington has had its own direct practice law since 2007. Now its insurance regulator wants the state to pay primary care a little like a DPC practice gets paid, and the draft bill says “direct primary care” out loud.

Insurance Commissioner Patty Kuderer will request legislation in the 2027 session to start designing a new way to finance and pay for primary care. Her office describes a fund that pools existing primary care money from multiple payers and pays providers predictable monthly payments instead of a fee for each service.

What the draft bill actually says

The draft text is short, three pages, and stamped “subject to change.” It creates no fund. It sets no rate. It directs the commissioner to design a primary care financing and payment model and report back.

Section 1 states the intent plainly. The legislature would pursue a model “through which affordable, timely, comprehensive primary care services could be accessed outside of traditional health insurance products.”

Section 2 lists what the design has to address. Among them:

• Reimbursement methods and rates, “including consideration of prospective, per member per month payments”
• Cutting administrative work such as coding, billing, prior authorization and credentialing
• “Primary care delivery models, such as advanced primary care, integration of behavioral health services into primary care, and direct primary care”
• How enrollees get attributed or assigned to practices
• State law changes or federal approvals the model would need, and how it gets funded

The commissioner would work with the governor, the Health Care Authority, the Department of Health and tribal leaders. The deadline for an implementation plan is June 30, 2028.

Why the state says it needs this

Washington already has a target. In 2022 the legislature directed the state’s cost board to measure primary care spending against a goal of 12 percent of total health care expenditures. The commissioner’s concept paper says spending “continues to hover around 4 percent.” The draft bill’s own findings call progress toward the goal “minimal.”

The concept paper describes a “multi-payor financed common fund” that pays practices per member per month for each patient attributed to them. Traditional insurance would “wrap around” and keep covering everything else. That is the same split many DPC patients already live with: a membership for primary care, a separate plan for the hospital.

The paper also names DPC directly. It says a growing number of Washingtonians are choosing to enroll in Direct Primary Care practices, and that large employers are paying for primary care directly, citing Boeing’s program. It credits those private models with promise, then adds that “they are unavailable or unaffordable to most Washingtonians.”

How big DPC is in Washington today

The commissioner’s office knows the numbers because it collects them. Washington’s direct practice law, chapter 48.150 RCW, requires practices to register with the agency, and the office reports to the legislature every year.

The December 2025 report counted 99 registered direct practices, up from 81. Enrollment rose 39.5 percent, from 31,419 patients to 43,841. That is about 0.54 percent of state residents. Monthly fees ranged from $40 to $2,000, and 32 percent of enrolled patients paid more than $100 a month. Fees vary by practice. The report notes that the law covers practices sometimes called retainer or concierge practices, too.

Most of these are small. The report found 89 percent had a single provider, and practices were located in 20 of Washington’s 39 counties.

So the agency proposing a monthly-payment model has its own long record of what DPC enrollment and pricing look like. It has reported on direct practices every year since 2009.

The gap between a membership and a fund

A DPC practice and a state fund both pay a set amount per patient per month. The resemblance mostly stops there.

A DPC physician sets the fee, signs a contract with the patient and answers to members who can leave. Under chapter 48.150, a registered direct practice also cannot bill an insurer for the primary care its agreement already covers. The concept paper lists a board, participation requirements, “aligned quality metrics,” attribution, and risk adjustment or reinsurance among the areas the design must consider. Those are the instruments of a payer.

The draft lists direct primary care as something to consider. It does not say whether a DPC practice could take fund payments, whether it could keep charging its own fee, or what happens to a patient who already pays one. Those are the questions a practice owner in Washington will want answered, and nothing published so far answers them.

What to watch

A bill number and a sponsor. The commissioner’s office calls this request legislation for the 2027 session. Until a legislator files it, the text can change, and the “direct primary care” language could stay, grow or disappear.

Who shows up to testify. The draft directs the commissioner to take input from consumers, primary care providers, facilities, unions and carriers. Whether Washington’s direct practices organize a voice in that process will shape how the model treats them.

The phase plan. The concept paper sketches five phases, from building the organization and IT systems through geographic pilots to state-regulated markets, then employer groups, then federal programs. A pilot would be the first point where a DPC practice could see an actual rate.

June 30, 2028. That is when the design is due, if the bill passes. For now, Washington has a draft that names DPC as a model to study, and the concept paper says the design work would be paid from the agency’s regulatory account. If you run a practice there, nothing about how you get paid changes until a design exists and lawmakers act on it.