Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 1312

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:

State Health Care Programs for Low-Income Individuals

The Basic Health Plan (BHP), Disability Lifeline (DL), and the Alcohol and Drug Addiction Treatment and Support Act program (ADATSA) are three of the largest programs in Washington that provide health care coverage to low-income individuals with state-only funds.

The Health Care Authority (Authority) administers the BHP, which is a health care insurance program that assists enrollees by providing a state subsidy to offset the costs of premiums. Residents of Washington with an income of less than 200 percent of Federal Poverty Level are eligible for enrollment in the BHP. In addition, the enrollee must not be: (1) eligible for Medicare; (2) institutionalized; or (3) in school on a temporary work visa.

In addition to administering the Medicaid program, the Department of Social and Health Services (Department) administers the medical care services program with state-only funds. Medical care services programs provide medical benefits to individuals enrolled in the DL and ADATSA programs. To be eligible for the DL program, an applicant must meet the same financial criteria as in the Temporary Assistance for Needy Families program and be incapacitated from gainful employment because of a physical or mental condition that is expected to last more than 90 days.

To be eligible for the ADATSA program, an individual must meet financial and incapacity eligibility criteria. The financial eligibility criteria are also equivalent to those in the Temporary Assistance to Needy Families program. The incapacity eligibility criteria are met when the applicant: (1) has a diagnosed chemical dependency on a psychoactive substance class; (2) has not abstained from alcohol and drug use during the prior 90 days; (3) has not been gainfully employed during the prior 30 days; and (4) is unable to work.

Federal Waiver

Medicaid is a federal-state program that provides health care services to specified categories of low-income individuals pursuant to federal standards. States may request a waiver from federal requirements for experimental, pilot, or demonstration projects. The 2010 supplemental budget directed the Authority and the Department to seek a waiver from the federal government to support some of the enrollees on the BHP and DL programs. As of January 2011 the federal government has issued the terms and conditions for granting a waiver. Under the terms of the waiver, the federal government will provide matching funds to Washington for those enrollees in the BHP, DL, and ADATSA programs whose income is at or below 133 percent of the Federal Poverty Level and who are citizens or eligible qualified aliens.

Summary of Bill:

Individuals who are eligible for federally-financed medical assistance programs cannot enroll in the Basic Health Plan (BHP). The Administrator of the Health Care Authority must identify BHP enrollees who are eligible for other coverage and transition them to federally-financed medical assistance programs. Applications for enrollment in the BHP must include a Social Security Number for each family member requesting coverage or an attestation that the person does not have a Social Security Number.

It is specified that medical care services through the Disability Lifeline program are not an entitlement and that funding may not exceed what is provided for in the budget. The Department of Social and Health Services is authorized to suspend new enrollment in medical care services for Disability Lifeline applicants and establish a waiting list of those who are eligible once there are sufficient funds.

Technical corrections are made to fix erroneous references.