BILL REQ. #: S-3533.1
State of Washington | 62nd Legislature | 2012 Regular Session |
Read first time 01/27/12. Referred to Committee on Health & Long-Term Care.
AN ACT Relating to medicaid cost containment through consumer engagement; amending RCW 74.09.055 and 74.09.470; creating new sections; and providing a contingent effective date.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
NEW SECTION. Sec. 1 In the face of daunting budgetary
constraints and significant and protracted fiscal tightening, the
legislature intends to enact the Washington state medicaid cost
containment act in order to allow the state to target scarce resources
to the most vulnerable beneficiaries, while upholding the integrity and
solvency of safety net programs through containing costs and increasing
consumer engagement. These goals will be achieved by applying premiums
to certain medical assistance populations with incomes over one hundred
fifty percent of the federal poverty level, and requiring eligibility
renewal every six months for certain populations. In recognition of
regulatory constraints imposed by the federal patient protection and
affordable care act of 2010, related to the maintenance of medicaid
eligibility, this legislation anticipates the enactment of the federal
state flexibility act of 2011 by congress or the secretary of the
United States department of health and human services exercising his or
her authority under section 1115 of the social security act to waive
maintenance of eligibility requirements.
Sec. 2 RCW 74.09.055 and 2011 1st sp.s. c 15 s 6 are each amended
to read as follows:
The authority is authorized to establish copayment, deductible, or
coinsurance, or other cost-sharing requirements for recipients of any
medical programs defined in RCW 74.09.010, except that premiums shall
not be imposed on children in households at or below ((two hundred
percent)) one hundred fifty percent of the federal poverty level.
Sec. 3 RCW 74.09.470 and 2011 1st sp.s. c 33 s 2 are each amended
to read as follows:
(1) Consistent with the goals established in RCW 74.09.402, through
the apple health for kids program authorized in this section, the
authority 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. In administering the program, the authority 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. The authority and the
caseload forecast council shall estimate the anticipated caseload and
costs of the program established in this section.
(2) The authority 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 authority 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)) recurring six-month 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 authority 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 authority shall use the same
eligibility redetermination and appeals procedures as those provided
for children on medical assistance programs. The authority shall
modify its eligibility renewal procedures to lower the percentage of
children failing to ((annually)) renew every six months. The authority
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 authority 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 authority 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
authority shall develop and implement a schedule of premiums for
children's health care coverage due to the authority from families with
income greater than two hundred percent of the federal poverty level.
For families with income greater than ((two)) one 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. For
children eligible for coverage under the federally funded children's
health insurance program, Title XXI of the federal social security act,
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. For children who are not eligible
for coverage under the federally funded children's health insurance
program, premiums shall be set every two years in an amount no greater
than the average state-only share of the per capita cost of coverage in
the state-funded children's health program.
(b) 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.
(c) Beginning no later than January 1, 2010, the authority 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 authority 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 authority shall collaborate with the department of
social and health services, 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 authority 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 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 authority 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.
NEW SECTION. Sec. 4 (1) Sections 2 and 3 of this act take effect
upon enactment of federal legislation modifying the federal patient
protection and affordable care act maintenance of eligibility
requirements as proposed in the federal state flexibility act of 2011.
(2) The health care authority shall notify the code reviser upon
the satisfaction of the conditions in subsection (1) of this section.
NEW SECTION. Sec. 5 This act may be known and cited as the
Washington state medicaid cost containment act.