Washington State House of Representatives Office of Program Research | BILL ANALYSIS |
Appropriations Committee |
ESB 5274
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. |
Brief Description: Concerning dental coverage for Pacific islanders residing in Washington.
Sponsors: Senators Hasegawa, Hunt, Wilson, C., Billig, Nguyen, Conway, Das, Frockt, Keiser, Randall and Saldaña.
Brief Summary of Engrossed Bill |
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Hearing Date: 4/3/19
Staff: Catrina Lucero (786-7192).
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. 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. Stand-alone dental plans may be offered on the health benefit exchange, but must be certified by the exchange. Federal premium subsidies are not available for dental plans offered to individuals on the exchange.
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 Legislature created the Pacific Island Citizens Health Care Premium Assistance Program (Premium Assistance Program) in 2018 to provide premium and cost sharing assistance to COFA citizens who enroll in a silver qualified health plan on the individual market, make less than 133 percent of the federal poverty level, and are ineligible for federal or state medical assistance programs.
Summary of Bill:
The COFA Islander Dental Program (Dental Program) is established. The Health Care Authority (HCA) must pay the premium for purchasing a qualified dental plan and the total out-of-pocket costs for services rendered by in-network dental providers, for eligible persons.
To be eligible for the program an individual must be eligible for the COFA Premium Assistance Program under RCW 43.71A.020 or:
be a Washington resident;
be a COFA citizen;
enroll in a qualified dental plan on the health benefit exchange;
have an income less than 133 percent of the federal poverty level; and
be enrolled in Medicare.
The HCA may disqualify a participant if they:
no longer meet eligibility criteria;
fail to comply with the Dental Program procedural or documentation requirements;
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 dental plans that are eligible for reimbursement by the Dental Program;
procedural requirements for participation in the Dental Program; and
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, 2020. The HCA, in consultation with the Washington Commission on Asian Pacific American Affairs, must establish a community education and outreach program to facilitate participation in the program. Funding for the education and outreach campaign is subject to appropriations.
Appropriation: None.
Fiscal Note: Available. New fiscal note requested on March 14, 2019.
Effective Date: The bill contains an emergency clause and takes effect immediately.