SENATE BILL REPORT

SB 5876

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Background: Medicaid is a federal-state partnership that provides an array of programs including medical care services, mental health services, long-term care services and support, and substance abuse and chemical dependency treatment. The Health Care Authority (HCA) is designated as the single-state agency for Medicaid, with responsibility for the medical programs. Other programs are coordinated with the Department of Social and Health Services (DSHS).

The array of Medicaid programs are available for specific eligibility categories, with mandatory and optional categories defined in federal law. Eligibility categories include persons that are aged, blind, and disabled; pregnant women; low-income children and their parents; foster children; and others. Over 50 Medicaid medical programs exist, serving approximately 1.2 million enrollees, of which 740,000 are children. Approximately 65 percent of the population is enrolled in managed care plans.

The federal Affordable Care Act included a number of changes for the Medicaid program, including streamlining of the eligibility process, with application of a modified adjusted gross income that will be applied to many existing programs and a new category of adults known as the expansion population. The expansion population includes adults ages 19 to 65 with incomes below 133 percent of the federal poverty level – approximately $14,856 per year for an individual, that are not otherwise eligible for Medicaid or Medicare. Enhanced federal funding is available to fund the new adults, starting with 100 percent in 2014, gradually declining to 90 percent in 2020. The Urban Institute estimates 494,000 adults may be newly eligible in Washington, and they estimated 250,000 of the newly eligible will enroll if an expansion is implemented.