BILL REQ. #:  S-3787.1 

Read first time 01/15/10.   Referred to Committee on Health & Long-Term Care.

     AN ACT Relating to the apple health community care demonstration waiver; amending RCW 74.09.5222; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION.  Sec. 1   The legislature finds that state funded health care coverage programs for the working poor and unemployable are at imminent risk of elimination due to growing fiscal pressures and the unsustainable rate at which health care costs increase. The urgent fiscal crisis is felt by many Washington residents who are experiencing their own budget difficulties and are now faced with losing the one option they had for affordable health care coverage.
     The legislature further finds that a situation of this magnitude demands creativity and foresight to maximize state and federal resources such that health care coverage can be maintained for the working poor and unemployable. It is understood that this may involve major restructuring and reordering of existing programs to be consistent with emerging federal legislation as well as current budget realities.
     The legislature further finds that it is in the interest of the state to provide seamless coverage options for families through an insurance exchange that helps subsidize coverage for the poor while providing a competitive market with quality coverage options for all residents regardless of income or assets.
     The legislature further finds that it would be irresponsible to implement any restructuring of state medical assistance programs that would create different classes of coverage based on the eligibility group in which one happens to be assigned. This hazard is best avoided through a streamlined approach that empowers individuals to make their own coverage decisions and provides subsidies where needed to achieve affordable coverage in the context of a health insurance exchange.

Sec. 2   RCW 74.09.5222 and 2009 c 545 s 4 are each amended to read as follows:
     (1) The department shall submit a section 1115 demonstration waiver request, or a series of section 1115 demonstration waiver requests to the federal department of health and human services to expand and revise the medical assistance program as codified in Title XIX of the federal social security act. The waiver request should be designed to ensure the broadest federal financial participation under Title XIX and XXI of the federal social security act. To the extent permitted under federal law, the waiver request should conform with any timely national health insurance reform developments and shall include the following components:
     (a) Establishment of a single eligibility standard for low-income persons, including expansion of categorical eligibility to include childless adults. The department shall request that the single eligibility standard be phased in such that incremental steps are taken to cover additional low-income parents and individuals over time, with the goal of ((offering)) making coverage ((to)) affordable for persons with household income at or below two hundred percent of the federal poverty level;
     (b) Establishment of a single seamless application and eligibility determination system for all state low-income medical programs included in the waiver with explicit flexibility for further coordination with and eventual merging with an insurance exchange if one is established in Washington state prior to January 1, 2015. Applications ((may)) must be ((electronic)) made available electronically and may include an electronic signature for verification and authentication. Eligibility determinations should maximize federal financing where possible;
     (c) The delivery of all low-income coverage programs as a single program or as part of an insurance exchange if one is established in Washington state prior to January 1, 2015, ((with)) to include: (i) A common core benefit package that may be similar to the basic health benefit package; or (ii) an alternative benefit package approved by the secretary of the federal department of health and human services, including the option of supplemental coverage for select categorical groups, such as children, and individuals who are aged, blind, and disabled; or (iii) if an insurance exchange is established, at least one insurance plan that is actuarially equivalent to the basic health plan benefit package;
     (d) A program design, or if an insurance exchange is adopted prior to January 1, 2015, incentives for authorized insurance plans to include creative and innovative approaches such as: Coverage for preventive services with incentives to use appropriate preventive care; enhanced medical home reimbursement, accountable care organization payment structure, and bundled payment methodologies; cost-sharing options; use of care management and care coordination programs to improve coordination of medical and behavioral health services; application of an innovative predictive risk model to better target care management services; and mandatory enrollment in managed care, ((as may be necessary)) only if applicable;
     (e) Until an insurance exchange is fully implemented in Washington state, the ability to impose enrollment limits or benefit design changes for eligibility groups that were not eligible under the Title XIX state plan in effect on the date of submission of the waiver application;
     (f) A premium assistance program through an insurance exchange whereby employers can participate in coverage options for employees and dependents of employees ((otherwise eligible under the waiver)) regardless of eligibility for subsidies in the exchange or other state coverage assistance. The waiver should make every effort to maximize enrollment in employer-sponsored health insurance when it is cost-effective for the state to do so, and the purchase is consistent with the requirements of Titles XIX and XXI of the federal social security act. To the extent allowable under federal law and only prior to an insurance exchange being fully implemented in Washington state, the department shall require enrollment in available employer-sponsored coverage as a condition of eligibility for coverage under the waiver; ((and))
     (g) The ability to share savings that might accrue to the federal medicare program, Title XVIII of the federal social security act, from improved care management for persons who are eligible for both medicare and medicaid. Through the waiver application process, the department shall determine whether the state could serve, directly or by contract, as a medicare special needs plan for persons eligible for both medicare and medicaid;
     (h) An implementation timeline mindful of national health insurance reform developments, including a detailed plan for the inclusion of categorically eligible medical assistance populations in an insurance exchange, subject to the state having fully implemented an insurance exchange by January 1, 2015; and
     (i) The ability to utilize federal matching funds to provide coverage to eligible medicaid enrollees in the context of an insurance exchange equal to the level of funding that would exist otherwise, subject to the state having fully implemented an insurance exchange by January 1, 2015.
     (2)(a) The department shall construct the waiver request around the conceptual framework of an insurance exchange that would serve any newly subsidized populations not otherwise eligible for medical assistance, as well as the current and expanded medical assistance population. The central goal of the waiver request should be providing streamlined, seamless coverage to subsidized and nonsubsidized populations in a competitive health insurance exchange, with adequate access, affordability, and quality measures employed.
     (3) The department shall hold ongoing stakeholder discussions as it is developing the waiver request, and provide opportunities for public review and comment as the request is being developed.
     (((3))) (4) The department and the health care authority shall identify statutory changes that may be necessary to ensure successful and timely implementation of the waiver request as submitted to the federal department of health and human services as the apple health ((program for adults)) community care program.
     (((4))) (5) The legislature must authorize implementation of any waiver approved by the federal department of health and human services under this section.