The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria. Washington's Medicaid program, known as Apple Health, offers a complete medical benefits package, including prescription drug coverage, to eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant women. The majority of Apple Health enrollees receive their coverage through managed care organizations (MCOs). The remainder receive their care through fee-for-service (FFS).
Early Periodic Screening, Diagnosis, and Treatment (EPSDT), also known as well-child checkups, are regular, complete health exams for children and youth intended to help identify and treat health issues early. EPSDT is a free health program for individuals, under the age of 21, enrolled in Apple Health coverage. The American Academy of Pediatrics' Bright Future Guidelines recommended schedule provides a total of 31 EPSDT visits from birth through age 20, whereas Apple Health only covers 22 EPSDT visits for the FFS enrollees. MCOs may exceed the FFS benefit and currently all five of the MCOs align their EPSDT benefit schedule with the Bright Future Guidelines.
The bill as referred to committee not considered.
Beginning January 1, 2023, HCA must ensure their schedule for covering Apple Health's EPSDT benefit aligns with the Bright Future Guidelines or a comparable standard.