BILL REQ. #: H-1009.1
State of Washington | 62nd Legislature | 2011 Regular Session |
Read first time 01/24/11. Referred to Committee on Health & Human Services Appropriations & Oversight.
AN ACT Relating to children's affordable health care coverage eligibility; amending RCW 74.09.470; providing an effective date; and declaring an emergency.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
Sec. 1 RCW 74.09.470 and 2009 c 463 s 2 are each amended to read
as follows:
(1)(a) Consistent with the goals established in RCW 74.09.402 and
subject to (c) of this subsection, through the apple health for kids
program authorized in this section, the department shall provide
affordable health care coverage to children under the age of nineteen
who reside in Washington state and whose family income at the time of
enrollment is not greater than two hundred fifty percent of the federal
poverty level as adjusted for family size and determined annually by
the federal department of health and human services, and effective
January 1, 2009, and only to the extent that funds are specifically
appropriated therefor, to children whose family income is not greater
than three hundred percent of the federal poverty level.
(b) In administering the program, the department shall take such
actions as may be necessary to ensure the receipt of federal financial
participation under the medical assistance program, as codified at
Title XIX of the federal social security act, the state children's
health insurance program, as codified at Title XXI of the federal
social security act, and any other federal funding sources that are now
available or may become available in the future.
(c) Effective for dates of service on or after March 1, 2011,
coverage under this section is limited to children who establish
eligibility under Title XIX or Title XXI programs of the federal social
security act.
(d) The department and the caseload forecast council shall estimate
the anticipated caseload and costs of the program established in this
section.
(2) The department shall accept applications for enrollment for
children's health care coverage; establish appropriate minimum-enrollment periods, as may be necessary; and determine eligibility
based on current family income. 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. The
application and annual renewal processes shall be designed to minimize
administrative barriers for applicants and enrolled clients, and to
minimize gaps in eligibility for families who are eligible for
coverage. If a change in family income results in a change in the
source of funding for coverage, the department shall transfer the
family members to the appropriate source of funding and notify the
family with respect to any change in premium obligation, without a
break in eligibility. The department shall use the same eligibility
redetermination and appeals procedures as those provided for children
on medical assistance programs. The department shall modify its
eligibility renewal procedures to lower the percentage of children
failing to annually renew. The department shall manage its outreach,
application, and renewal procedures with the goals of: (a) Achieving
year by year improvements in enrollment, enrollment rates, renewals,
and renewal rates; (b) maximizing the use of existing program databases
to obtain information related to earned and unearned income for
purposes of eligibility determination and renewals, including, but not
limited to, the basic food program, the child care subsidy program,
federal social security administration programs, and the employment
security department wage database; (c) streamlining renewal processes
to rely primarily upon data matches, online submissions, and telephone
interviews; and (d) implementing any other eligibility determination
and renewal processes to allow the state to receive an enhanced federal
matching rate and additional federal outreach funding available through
the federal children's health insurance program reauthorization act of
2009 by January 2010. The department shall advise the governor and the
legislature regarding the status of these efforts by September 30,
2009. The information provided should include the status of the
department's efforts, the anticipated impact of those efforts on
enrollment, and the costs associated with that enrollment.
(3) To ensure continuity of care and ease of understanding for
families and health care providers, and to maximize the efficiency of
the program, the amount, scope, and duration of health care services
provided to children under this section shall be the same as that
provided to children under medical assistance, as defined in RCW
74.09.520.
(4) The primary mechanism for purchasing health care coverage under
this section shall be through contracts with managed health care
systems as defined in RCW 74.09.522, subject to conditions,
limitations, and appropriations provided in the biennial appropriations
act. However, the department shall make every effort within available
resources to purchase health care coverage for uninsured children whose
families have access to dependent coverage through an employer-sponsored health plan or another source when it is cost-effective for
the state to do so, and the purchase is consistent with requirements of
Title XIX and Title XXI of the federal social security act. To the
extent allowable under federal law, the department shall require
families to enroll in available employer-sponsored coverage, as a
condition of participating in the program established under this
section, when it is cost-effective for the state to do so. Families
who enroll in available employer-sponsored coverage under this section
shall be accounted for separately in the annual report required by RCW
74.09.053.
(5)(a) To reflect appropriate parental responsibility, the
department shall develop and implement a schedule of premiums for
children's health care coverage due to the department from families
with income greater than two hundred percent of the federal poverty
level. For families with income greater than two hundred fifty percent
of the federal poverty level, the premiums shall be established in
consultation with the senate majority and minority leaders and the
speaker and minority leader of the house of representatives. Premiums
shall be set at a reasonable level that does not pose a barrier to
enrollment. The amount of the premium shall be based upon family
income and shall not exceed the premium limitations in Title XXI of the
federal social security act. Premiums shall not be imposed on children
in households at or below two hundred percent of the federal poverty
level as articulated in RCW 74.09.055.
(b) Beginning no later than January 1, 2010, the department shall
offer families whose income is greater than three hundred percent of
the federal poverty level the opportunity to purchase health care
coverage for their children through the programs administered under
this section without an explicit premium subsidy from the state. The
design of the health benefit package offered to these children should
provide a benefit package substantially similar to that offered in the
apple health for kids program, and may differ with respect to cost-sharing, and other appropriate elements from that provided to children
under subsection (3) of this section including, but not limited to,
application of preexisting conditions, waiting periods, and other
design changes needed to offer affordable coverage. The amount paid by
the family shall be in an amount equal to the rate paid by the state to
the managed health care system for coverage of the child, including any
associated and administrative costs to the state of providing coverage
for the child. Any pooling of the program enrollees that results in
state fiscal impact must be identified and brought to the legislature
for consideration.
(6) The department shall undertake and continue a proactive,
targeted outreach and education effort with the goal of enrolling
children in health coverage and improving the health literacy of youth
and parents. The department shall collaborate with the department of
health, local public health jurisdictions, the office of the
superintendent of public instruction, the department of early learning,
health educators, health care providers, health carriers, community-based organizations, and parents in the design and development of this
effort. The outreach and education effort shall include the following
components:
(a) Broad dissemination of information about the availability of
coverage, including media campaigns;
(b) Assistance with completing applications, and community-based
outreach efforts to help people apply for coverage. Community-based
outreach efforts should be targeted to the populations least likely to
be covered;
(c) Use of existing systems, such as enrollment information from
the free and reduced-price lunch program, the department of early
learning child care subsidy program, the department of health's women,
infants, and children program, and the early childhood education and
assistance program, to identify children who may be eligible but not
enrolled in coverage;
(d) Contracting with community-based organizations and government
entities to support community-based outreach efforts to help families
apply for coverage. These efforts should be targeted to the
populations least likely to be covered. The department shall provide
informational materials for use by government entities and community-based organizations in their outreach activities, and should identify
any available federal matching funds to support these efforts;
(e) Development and dissemination of materials to engage and inform
parents and families statewide on issues such as: The benefits of
health insurance coverage; the appropriate use of health services,
including primary care provided by health care practitioners licensed
under chapters 18.71, 18.57, 18.36A, and 18.79 RCW, and emergency
services; the value of a medical home, well-child services and
immunization, and other preventive health services with linkages to
department of health child profile efforts; identifying and managing
chronic conditions such as asthma and diabetes; and the value of good
nutrition and physical activity;
(f) An evaluation of the outreach and education efforts, based upon
clear, cost-effective outcome measures that are included in contracts
with entities that undertake components of the outreach and education
effort;
(g) An implementation plan to develop online application capability
that is integrated with the department's automated client eligibility
system, and to develop data linkages with the office of the
superintendent of public instruction for free and reduced-price lunch
enrollment information and the department of early learning for child
care subsidy program enrollment information.
(7) The department shall take action to increase the number of
primary care physicians providing dental disease preventive services
including oral health screenings, risk assessment, family education,
the application of fluoride varnish, and referral to a dentist as
needed.
(8) The department shall monitor the rates of substitution between
private-sector health care coverage and the coverage provided under
this section and shall report to appropriate committees of the
legislature by December 2010.
NEW SECTION. Sec. 2 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
March 1, 2011.