BILL REQ. #: H-0628.2
State of Washington | 59th Legislature | 2005 Regular Session |
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.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
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.