FINAL BILL REPORT

ESB 5274

PARTIAL VETO

C 311 L 19

Synopsis as Enacted

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.

Senate Committee on Health & Long Term Care

Senate Committee on Ways & Means

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. 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.

In 2018, the Pacific Island Citizens Health Care Premium Assistance Program (Premium Assistance Program) was enacted to provide premium 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, and are ineligible for federal or state medical assistance programs.

Summary: The COFA islander dental care program (Dental Program) is established, requiring the Health Care Authority (HCA) to provide dental services that are covered under the medical assistance dental program to eligible COFA islanders, beginning January 1, 2020.

COFA islanders are eligible for the Dental Program, if they are eligible for the Premium Assistance Program, or if they:

• are a Washington resident;

• enroll in a qualified dental plan on the health benefit exchange;

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

• are enrolled in Medicare.

A person is disqualified for the Dental Program 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;

• procedural requirements for continued participation in the program; and

• an annual comprehensive community education and outreach campaign for both the premium assistance and dental programs.

In establishing the annual education and outreach campaign, HCA must consult with the Washington State Commission on Asian Pacific American Affairs.

The Premium Assistance Program advisory committee must advise the HCA on the Dental Program. Reimbursement for advisory committee members' transportation and travel expenses is no longer made subject to appropriations.

Votes on Final Passage:

Partial Veto Summary:

• Removed section declaring an emergency and having the act take effect immediately.