State auditors: Initiative 1163 improved some safety protections but certification delays hamper home‑care supply

The Joint Legislative Audit and Review Committee on July 15 heard a State Auditor's Office presentation finding that Initiative 1163 — the 2011 voter-approved law creating home care aide certification requirements — established protections that can increase safety for vulnerable clients, but that lengthy certification timelines and process complexity have contributed to workforce shortages.

At the hearing, SAO assistant director Justin Stowe introduced auditors who conducted the review. "At a high level, the audit found some I‑1163 requirements make people safer, but safety depends on access to care, and Washington has a long‑term care workforce shortage," said Corey Crowley Hall of the State Auditor's Office.

The audit summarized how Initiative 1163 requires 75 hours of training, a hands‑on skills test, a written knowledge test, FBI background checks and a registry of substantiated findings. Auditors told the committee that in fiscal year 2024 roughly 13,000 people applied for certification but only about 5,000 were certified, leaving nearly 8,000 applicants who started the process but did not complete it.

Auditors flagged timeliness as a major problem: state law directs agencies to certify applicants within 200 days of hire, but in fiscal 2025 only about one‑third met that legal deadline; auditors reported the average time from hire to certification was about 463 days. The report attributes delays to several causes, including long waits between training and testing, limited testing access in rural areas, Prometric scheduling policies that cancel exams with low registration, DOH processing time following tests, and DOH's additional verification of FBI background checks after employers already run them at hire.

To reduce wasted work and speed certification, SAO recommended that DOH accept applications only from candidates who have completed training and testing (a practice used in other states) and that the legislature consider amending state law to eliminate DOH's redundant verification of FBI checks. Auditors also recommended continued expansion of integrating testing into training programs; SAO noted programs that administer tests at the end of training produced faster certifications and higher pass rates.

Michelle Fellowes, one of the auditors, summarized the pipeline data: "Of the roughly 13,000 applicants in fiscal year 2024, only 5,000 were certified." The auditors also reported disparities in use of authorized Medicaid long‑term care hours — for example, children without individual providers and Native American clients were less likely to use their full approved hours — which the report cites as potential indicators of access problems.

Department of Health assistant secretary Shawna Fox and Tracy Drake, director of the Home Care Aide Program, told the committee the department has implemented several operational changes in recent years: allowing students to schedule exams while still in training, using temporary legislative funding to triple credentialing staff to work down backlog, updating rules, and moving exams into more training programs. "The department appreciates the SAO recognition of challenges to the home care aide credentialing process," Fox said, and DOH agreed with SAO's recommendation to continue integrating testing into training and to eliminate redundant FBI verification.

Christine Morris, DSHS office chief for training communications and workforce development, said DSHS and DOH have coordinated closely and that testing is now offered in multiple languages; she reported the state provides tests in 13 languages and supported the auditors' path to further integration of testing and training.

Committee members asked SAO whether it examined Prometric's contract performance standards and whether the audit evaluated language access and immigration impacts on workforce supply. Auditors said the contract included reporting requirements but lacked formal performance standards and that the audit did not analyze immigration status; they said they would follow up on language‑access specifics if requested.

No formal votes were taken at the hearing; the committee invited agencies to prepare collaborative budget and statutory requests to implement audit recommendations and encouraged early outreach to affected committee chairs. The committee received no public testimony and adjourned after the agencies' responses.