FINAL BILL REPORT

SSB 5683

C 161 L 18

Synopsis as Enacted

Brief Description: Concerning health care for Pacific Islanders residing in Washington under a compact of free association.

Sponsors: Senate Committee on Ways & Means (originally sponsored by Senators Saldaña, Kuderer, Cleveland, Hasegawa, Darneille, Hunt, Conway, Keiser, Hobbs, McCoy and Pedersen).

Senate Committee on Health Care

Senate Committee on Ways & Means

House Committee on Health Care & Wellness

House Committee on Appropriations

Background: Under the federal Patient Protection and Affordable Care Act (ACA), each state must establish a health benefit exchange through which consumers may compare and purchase individual and small group coverage, access premium and cost-sharing subsidies, and apply for Medicaid coverage. Premium subsidies are available to individuals between 100 percent and 400 percent of the federal poverty level. Qualified health plans sold in an exchange must meet certain standardized actuarial values: Bronze, 60 percent; Silver, 70 percent; Gold, 80 percent; and Platinum, 90 percent. Washington’s health benefit exchange, the Washington Healthplanfinder, is a public-private partnership governed by a board consisting of members with expertise in the health care system and health care coverage.

Under the Compact of Free Association (COFA), citizens of the Republic of the Marshall Islands, the Federated States of Micronesia, and the Republic of Palau may live and work in the United States and serve in the United States Military. Citizens of COFA nations are also eligible for premium assistance through the Exchanges established by the ACA. Citizens of COFA nations are, however, ineligible for Medicaid.

The State Board of Health (Board), in collaboration with the Governor's Interagency Council on Health Disparities, may complete health impact reviews on legislative proposals to evaluate the proposals' impact on health and health disparities. In 2016, the Board completed a health impact review on HB 2986 (2016), which created a premium assistance program for citizens of COFA nations. The Board determined that the program would improve access and outcomes for COFA citizens and decrease health disparities.

Summary: The COFA Premium Assistance Program (Program) is established. Through the Program, the Health Care Authority (HCA) must, within funds appropriated for the specific funds, pay the premiums and out-of-pocket costs associated with a qualified health plan purchased by an eligible individual. A person is eligible for the Program if they:

• are a Washington resident;

• are a citizen of a COFA nation;

• enroll in a Silver plan;

• have an income that is less than 133 percent of the federal poverty level; and

• are ineligible for all federal or state medical assistance programs administered by the HCA.

A person is disqualified for the program if they:

• no longer meet the eligibility criteria;

• fail to comply with the Program requirements related to procedures or documentation;

• fail to notify HCA of a change of address in a timely manner;

• withdraw their application or request termination of coverage; or

• commit fraud that results in an insurer rescinding the policy.

The HCA must establish:

• application, enrollment, and renewal processes;

• the qualified health plans that are eligible for reimbursement by the Program;

• procedural requirements for participation in the Program;

• open enrollment and special enrollment periods consistent with the enrollment periods of the Washington Healthplanfinder—the first open enrollment period must begin by November 1, 2018; and

• a comprehensive community education and outreach campaign that must begin no later than September 1, 2018, and subject to amounts appropriated for this purpose, this education and outreach shall be culturally and linguistically appropriate.

HCA must appoint an advisory committee (Committee) that must include insurers and representatives of communities of citizens of COFA nations. The Committee must advise the HCA in the development, implementation, and operation of the Program. The Committee shall exist until at least December 31, 2019. Subject to amounts appropriated for this purpose, Committee members may be reimbursed for travel expenses related to the Committee, as needed.

By December 31, 2019, HCA must report to the Governor and the Legislature on the implementation of the Program. The report must include:

• the number of people participating in the program;

• the actual costs of the program compared to predicted costs;

• the results of the community education and outreach campaign; and

• funding needed to continue the program through the end of the biennium.

Votes on Final Passage: