BILL REQ. #:  H-0628.2 


State of Washington59th Legislature2005 Regular Session

By Representatives Clibborn, Morrell, Campbell, Cody, Tom, Moeller, Schual-Berke, Wallace, Grant, Williams, Lovick, Ormsby, Chase, Kessler, Kagi, Hunt, Appleton, Darneille, Upthegrove, Sells, Roberts, Conway, Miloscia, Fromhold, P. Sullivan, Santos, Takko, Green, Wood, Simpson and Hasegawa

Read first time 01/24/2005.   Referred to Committee on Health Care.

     AN ACT Relating to health insurance coverage for children; amending RCW 74.09.055 and 74.09.415; adding new sections to chapter 74.09 RCW; providing an effective date; and declaring an emergency.


NEW SECTION.  Sec. 1   A new section is added to chapter 74.09 RCW to read as follows:
     (1) The legislature finds that:
     (a) The health of the children of Washington state is critical to their success in school and throughout their lives. Children with health insurance coverage have better health outcomes than those who lack coverage. Children without health insurance coverage are more likely to be in poor health and more likely to delay receiving, or go without, needed health care services;
     (b) Access to preventive and well-child health services for children is a cost-effective investment of both public and private dollars that improves the health of children and of our communities at large; and
     (c) Health care coverage for children in Washington state is the product of critical efforts in both the private and public sectors to help children succeed. Employers are an integral part of children's health insurance coverage. In 2004, almost sixty percent of children in Washington had employer-sponsored or other private coverage. This coverage is complemented by public programs that meet needs of low-income children whose parents are not offered health insurance coverage through their employer or who cannot otherwise afford the costs of coverage. In 2004, thirty-five percent of children in Washington state had some form of public health coverage. Yet, even with the efforts of both the private and public sectors, too many children in Washington state lack health insurance coverage. In 2004, almost one hundred thousand children were uninsured. Two-thirds of these children are low income.
     (2) It is therefore the intent of the legislature that all children in the state of Washington have health care coverage by 2010. This should be accomplished by building upon and strengthening the successes of employer-sponsored health insurance coverage, other sources of private coverage, and publicly supported children's health insurance programs in Washington state. Access to coverage should be streamlined and efficient, with reductions in unnecessary administrative costs and mechanisms to expeditiously link children with a medical home.

Sec. 2   RCW 74.09.055 and 2003 1st sp.s. c 14 s 1 are each amended to read as follows:
     (1) Except to the extent provided in subsection (2) of this section, the department is authorized to establish copayment, deductible, coinsurance, or other cost-sharing requirements for recipients of any medical programs defined in RCW 74.09.010.
     (2) The department shall not establish premium requirements for children or pregnant women eligible for medical assistance as defined in RCW 74.09.510 or the children's health program as defined in RCW 74.09.415.

NEW SECTION.  Sec. 3   A new section is added to chapter 74.09 RCW to read as follows:
     Eligibility review periods for children and pregnant women eligible for medical assistance as defined in RCW 74.09.510 and children eligible for the children's health program as defined in RCW 74.09.415 shall be no more frequent than every twelve months.

Sec. 4   RCW 74.09.415 and 2002 c 366 s 2 are each amended to read as follows:
     (((1))) There is hereby established a program to be known as the children's health program.
     To the extent of available funds:
     (((a))) (1) Health care services may be provided to persons who are under eighteen years of age with household incomes at or below the federal poverty level ((and)) not otherwise eligible for medical assistance or the limited casualty program for the medically needy.
     (((b))) (2) The determination of eligibility of recipients for health care services shall be the responsibility of the department. The application process shall be easy to understand and, to the extent possible, applications shall be made available at local schools and other appropriate locations. The department shall make eligibility determinations within the time frames for establishing eligibility for children on medical assistance, as defined by RCW 74.09.510.
     (((c))) (3) The amount, scope, and duration of health care services provided to eligible children under the children's health program ((shall)) may be the same as that provided to children under medical assistance, as defined in RCW 74.09.520. In the event that available funding is not sufficient to provide the amount, duration, and scope of services provided to children under medical assistance, the department shall make every effort to define covered services in a manner that provides coverage for clinically proven preventive services and meets the needs of children with special health care needs.
     (((2) The legislature is interested in assessing the effectiveness of the prenatal care program. However, the legislature recognizes the cost and complexity associated with such assessment.
     The legislature accepts the effectiveness of prenatal and maternity care at improving birth outcomes when these services are received by eligible persons. Therefore, the legislature intends to focus scarce assessment resources to determine the extent to which support services such as child care, psychosocial and nutritional assessment and counseling, case management, transportation, and other support services authorized by chapter 296, Laws of 1990, result in receipt of prenatal and maternity care by eligible persons.
     The University of Washington shall conduct a study, based on a statistically significant statewide sampling of data, to evaluate the effectiveness of the maternity care access program set forth in RCW 74.09.760 through 74.09.820 based on the principles set forth in RCW 74.09.770.
     The University of Washington shall develop a plan and budget for the study in consultation with the joint legislative audit and review committee. The joint legislative audit and review committee shall also monitor the progress of the study.
     The department of social and health services shall make data and other information available as needed to the University of Washington as required to conduct this study.
     The study shall determine:
     (a) The characteristics of women receiving services, including health risk factors;
     (b) The extent to which access to maternity care and support services have improved in this state as a result of this program;
     (c) The utilization of services and birth outcomes for women and infants served by this program by type of practitioner;
     (d) The extent to which birth outcomes for women receiving services under this program have improved in comparison to birth outcomes of nonmedicaid mothers;
     (e) The impact of increased medicaid reimbursement to physicians on provider participation;
     (f) The difference between costs for services provided under this program and medicaid reimbursement for the services;
     (g) The gaps in services, if any, that may still exist for women and their infants as defined by RCW 74.09.790 (1) and (4) served by this program, excluding pregnant substance abusers, and women covered by private health insurance; and
     (h) The number and mix of services provided to eligible women as defined by subsection (2)(g) of this section and the effect on birth outcomes as compared to nonmedicaid birth outcomes.

NEW SECTION.  Sec. 5   A new section is added to chapter 74.09 RCW to read as follows:
     To the extent funding is provided in the biennial operating budget, the department may contract with local public health entities, community organizations, and health care providers to conduct outreach and enrollment assistance activities for low-income families who do not have access to affordable health insurance coverage. Every effort shall be made to obtain private, federal Title XIX matching funds and federal Title XXI matching funds for these activities.

NEW SECTION.  Sec. 6   This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and takes effect July 1, 2005.

--- END ---