6038-S2 AMS ZARE MOOR 050
2SSB 6038 - S AMD 236
By Senator Zarelli
On page 3, line 20, after "income" strike "at the time of enrollment"
On page 3, line 23, after "services;" strike "and"
On page 3, line 26, after "plan;" insert the following:
"(vii) who is a United States citizen or legally admitted for permanent residence; and
(viii) whose family liquid assets do not exceed an amount established by the administrator in rule;"
On page 3, line 28, after "(vi)" insert "through (viii)"
On page 3, line 36, after "(vi)" insert "through (viii)"
On page 4, after line 37, insert the following:
"NEW SECTION. Sec. 3. A new section is added to chapter 70.47 RCW to read as follows:
The administrator shall establish a waiting period subsidized enrollee applicants are required to have without private insurance before enrolling in the program under this chapter. The waiting period shall be at least four months and waived only when:
(1) The prospective enrollee has a medical condition that, without treatment, would be life-threatening or cause serious disability; or
(2) The loss of employer sponsored dependent coverage is due to either loss of employment, the death of the employee, or the employer discontinues the option of dependent coverage."
On page 9, after line 8, insert the following:
"(7) Subject to subsection (5) of this section, enroll any eligible person for whom a completed application is submitted. In determining eligibility, the administrator shall require submission of income tax returns, or verification that income tax returns were not filed, and recent income history for any applicant, the applicant's spouse, and his or her dependents."
On page 12, after line 18, insert the following:
"(20)(a) Disenroll any enrollee:
(i) Whose premium payments to the plan are delinquent;
(ii) Who, as reported by health care providers and confirmed by the
administrator, repeatedly fails to pay the required copayments or coinsurance
in full on a timely basis;
(iii) Who does not meet the eligibility standards established in RCW
70.47.020(6); or
(iv) As necessary to meet the requirements of subsection (5) of this section;
(b) To verify continued eligibility, check employment security payroll
records at least once every twelve months on all enrollees; require any
enrollee whose family income as indicated by payroll records exceeds that upon
which his or her enrollment and subsidy level is based to document his or her
current family income as a condition of continued eligibility; and require any
enrollee for whom employment security payroll records cannot be obtained to
document his or her current family income at least once every six months;
(c) Provide an enrollee subject to disenrollment with advance written
notice. Upon disenrollment, the administrator shall promptly notify the
managed health care system in which the enrollee has been enrolled, and shall
not be responsible for payment of health care services provided to the
enrollee, including if applicable members of the enrollee's family, after the
date of notification."
Renumber the sections consecutively and correct any internal references accordingly.
2SSB 6038 - S AMD 236
By Senator Zarelli
On page 1, line 2 of the title, after "50.20.210;" insert "adding a new section to chapter 70.47 RCW;"
EFFECT: Amends eligibility for the Basic Health Plan.
· Requires enrollees to be a citizen or legally admitted to the United States;
· Requires an asset test, in addition to income requirements;
· Requires enrollees be uninsured for at least four months prior to enrolling, unless the enrollee has a serious medical condition or has lost employer sponsored coverage due to loss of employment or the employer discontinued coverage;
Requires Health Care Authority to check employment security payroll records at least once every twelve months on every enrollee to verify continued eligibility.
Authorizes disenrollment of enrollees who do not make premium payments or repeatedly fail to pay copayments on a timely basis.
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