AN ACT Relating to children's health; amending RCW 74.09.010; adding a new section to chapter 43.20 RCW; and adding new sections to chapter 74.09 RCW.

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

NEW SECTION. Sec. 1. The legislature finds that the state of children's health in the state of Washington is suffering. More and more, children are living in poverty, putting them at risk for health and social problems. Access to health care is diminishing, especially in rural areas where health care providers may not be available. There are communities in Washington where physicians do not accept low-income children as patients. Many children are uninsured or underinsured.

These factors, and others, are contributing to the declining state of children's health. The ramifications on the state are widespread and long term. The investment in preventive health care programs contributes to the benefit of all citizens and is a sound approach to health care cost containment.

It is the purpose of sections 3 and 4 of this act to provide, consistent with appropriated funds, health care access and services to the young citizens in this state. To this end, a child health care system is established based on the following principles:

(1) The family is the fundamental unit in our society and should be supported through public policy.

(2) Access to preventive and other health care services should be made more readily available for eligible children.

(3) Unnecessary barriers to health care for eligible persons should be removed.

(4) The status of children's health and the access to health care providers should be evaluated at appropriate intervals to determine effectiveness and need for modification.

(5) Health care services should be delivered in a cost-effective manner.

NEW SECTION. Sec. 2. For the purposes of sections 3, 4, and 5 of this act, "poverty" means at or below the federal poverty level as annually defined by the federal department of health and human services and adjusted for family size.

NEW SECTION. Sec. 3. There is hereby established a new program financed by state funds to be known as the children's health program.

To the extent of available state funds:

(1) Medical care may be provided to persons who are under eighteen years of age with household incomes at or below the federal poverty level and not otherwise eligible for medical assistance or the limited casualty program for the medically needy.

(2) The determination of eligibility of recipients for medical care shall be the responsibility of the department. The application process shall be easy to understand, and the department shall make eligibility determinations within the timeframes for establishing eligibility for children on medical assistance, as defined by RCW 74.09.520.

(3) The amount, scope, and duration of medical care provided to eligible children under the children's health program shall be the same as that provided to children under medical assistance, as defined in RCW 74.09.520.

NEW SECTION. Sec. 4. Local communities are encouraged to take actions necessary to make health care more accessible to children in their communities, such as coordinating the development of alternative provider relationships. To assist communities in their efforts:

(1) The department, in coordination with the department of health, shall provide technical assistance to local communities in order to develop provider resources and expand coordinated provision of health care to children in poverty. The department shall focus on those areas identified as having a significant problem with access to care for children in poverty, and on those areas needing to develop alternative delivery systems of care.

(2) The department, in coordination with the department of health, shall identify counties, or parts of counties, experiencing significant problems with access to health care for children eligible for services under chapter 74.09 RCW, based on a variety of indicators, such as:

(a) Number of primary care providers for children;

(b) Percent of the population in poverty;

(d) Number of school children with handicapping conditions;

(e) Early and periodic screening, diagnosis, and treatment (EPSDT) utilization;

(f) Teen birth rate; and

(g) Low birth weight rate.

(3) To the extent funding is available, the department shall provide financial incentives, such as disproportionate share payments and grants to local health care providers. The department shall target financial incentives to those areas identified as having a significant problem with access to care for children in poverty and on those areas needing to develop alternative delivery systems of care.

(4) The department, in coordination with the department of health, shall reevaluate the state of access to care for children on at least a biennial basis and shall provide this information, along with information on the implementation of this section, to the board of health for inclusion in the biennial state health report.

NEW SECTION. Sec. 5. A new section is added to chapter 43.20 RCW to read as follows:

Beginning in 1992, the biennial state health report under RCW 43.20.050 shall include a specific section on the state of children's health. This section shall include information provided by the department of social and health services and the department of health, pursuant to section 4 of this act.

Sec. 6. Section 74.09.010, chapter 26, Laws of 1959 as last amended by section 11, chapter 406, Laws of 1987 and RCW 74.09.010 are each amended to read as follows:

As used in this chapter:

(1) "Department" means the department of social and health services.

(2) "Secretary" means the secretary of social and health services.

(3) "Internal management" means the administration of medical assistance, medical care services, the children's health program, and the limited casualty program.

(4) "Medical assistance" means the federal aid medical care program provided to categorically needy persons as defined under Title XIX of the federal social security act.

(5) "Medical care services" means the limited scope of care financed by state funds and provided to general assistance recipients, and recipients of alcohol and drug addiction services provided under chapter 74.50 RCW.

(6) "Limited casualty program" means the medical care program provided to medically needy persons as defined under Title XIX of the federal social security act, and to medically indigent persons who are without income or resources sufficient to secure necessary medical services.

(7) "Nursing home" means nursing home as defined in RCW 18.51.010.

(8) "Children's health program" means the medical care program financed by state funds and provided to children under eighteen years of age and in households with incomes at or below the federal poverty level as annually defined by the federal department of health and human services as adjusted for family size, and who are not otherwise eligible for medical assistance or the limited casualty program for the medically needy.

NEW SECTION. Sec. 7. Sections 1 through 4 of this act are each added to chapter 74.09 RCW.