Laying groundwork for digital medical certification in Washington’s Paid Leave program
Washington Employment Security Department
July 2026 - October 2026
Why This Matters For Families
Over the past 20 years, 14 states and D.C. have adopted paid family and medical leave (PFML) programs that provide income support to families when new children arrive, a family member needs care, or a family breadwinner suffers a personal health issue. Paid leave is associated with higher labor force participation rates, higher earnings over time, better health, worker retention and productivity, and economic growth. To extend those benefits to more Americans, it is essential to pass more state policies and, ideally, a national policy — and ensure those policies are designed and implemented to serve the workers and families who are most in need.
The New Practice Lab team is working directly with state administrators, as well as the individuals and families whom they serve, to streamline state paid leave program benefits. The team has also offered guidance to states working to pass paid family and medical leave laws, offering advice on policy language and processes that will aid benefit delivery to claimants and families. These programs can provide critical relief to U.S. families — but only if they reach the people who need them, when they need them.
Implementation Challenge
Across state paid leave programs, medical certification is a consistent source of delays, friction, and paperwork errors. Making it easier for healthcare providers to submit the information that programs need could help workers complete their applications more quickly and receive benefits sooner, while also saving the state time and freeing up resources for other program functions.
The New Practice Lab previously helped Minnesota’s paid leave program explore a novel approach to medical certification, incorporating leave certification directly into the electronic health record systems that healthcare providers use.
Washington Paid Leave was interested in adapting this approach, but first needed to complete the due diligence required to determine whether and how it could work in Washington, including developing a resourcing request for state legislators to consider that would fund the scaled development. This meant understanding how EHR-integrated certification could work within Washington’s technical environment, what resources and legislative support implementation would require, and how the certification workflow could work for leave takers, healthcare providers, and program staff.
Our Approach
The New Practice Lab worked with Washington Paid Leave to translate the EHR-integrated certification concept into an approach tailored to Washington’s policy, technical, and operational environment. Building on lessons from our earlier work in Minnesota and our concurrent work in Colorado, we are:
Assessing Washington’s technical environment, working with technical staff from Washington Paid Leave, the state Health Care Authority, the state technology services department, and other state stakeholders to identify implementation considerations and develop written recommendations for the Paid Leave program’s approach to digital certification.
Supporting Washington’s growing technical capacity by providing guidance and reference materials as the Paid Leave data team prepared to hire its first data engineers, and offering feedback on improvements to its underlying data systems to equip future technical work undertaken by the program.
Communicating needs and preferences that medical providers have when certifying public benefits like Paid Leave, sharing insights gleaned through our prior interview-based research in Minnesota, our concurrent interview-based research in Colorado, and desk research.
Designing improved certification workflows that incorporate digital certification through providers’ EHR systems, drawing on lessons from Minnesota and Colorado to develop an approach tailored to Washington and the needs of leave takers, healthcare providers, and program staff. The resulting workflows, delivered as visual process flows and written technical scoping documents, will help Washington Paid Leave scope the size and nature of a digital certification implementation effort, help the program explain the effort to the state’s legislature, and give the state a head start on procurement and design if and when the decision package is approved by the legislature.
Drafting technical sections of a decision package describing the proposed approach and alternatives for consideration by the state legislature.
What We Learned
While this work is still underway, the engagement is helping clarify what it would take for Washington to pursue an EHR-integrated medical certification pathway. Building on lessons from Minnesota, we are learning how the approach needs to be adapted to Washington’s specific technical environment, program workflows, and legislative and funding context.
We expect that Washington will use our work to secure funding for and then begin implementing an EHR-integrated certification pathway. If implemented, EHR-integrated certification could reduce burden on healthcare providers and shorten the time it takes for a leave taker to submit a medical certification document to the state. It could also improve Washington Paid Leave’s operations through simpler workflows for processing medical certification documents, more comprehensive and reliable program data, and more robust program integrity. Our current work is helping Washington assess these potential benefits and build the technical and legislative case for moving forward.
Next Steps
Washington Paid Leave will use the groundwork developed through this engagement as it considers funding and implementation of an EHR-integrated certification pathway for Paid Leave claims. NPL may continue to provide targeted technical assistance as the work progresses.
This project, combined with our work in Colorado, will allow us to provide comprehensive guidance to future states that pursue EHR-integrated leave certification pathways, a topic of great interest to the broader ecosystem of states with state-based PFML programs.
