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Washington State: Universal Children's Coverage and Purchasing Pool

Washington State enacted major health reforms this past year, including bills aiming to extend universal coverage to children and creating a new purchasing pool that offers subsidized coverage for low-income workers.

In March, Governor Christine Gregoire (D) signed legislation (Senate Bill 5093) intended to extend access to health coverage to all children in the state. It expands SCHIP eligibility to children with family incomes up to 300 percent of the FPL ($62,000 for a family of four) by January 2009, with premiums for families between 200 and 300 percent of FPL tied to a sliding scale. Families with access to employer-sponsored insurance may be required to enroll in this private coverage in order to obtain public subsidies, if this is deemed to be cost-effective to the state. Higher-income families may buy in to the public coverage program by paying the full cost.

The coverage links children with medical homes, to ensure they obtain preventive care and routine check-ups. The bill also contains provisions to streamline SCHIP enrollment and recertification and encourage healthy lifestyles through school lunch and exercise programs. In addition, it ties reimbursement of health care providers to performance.

In early May, Governor Gregoire signed into law health reform measures intended to expand access to affordable coverage. [1] The measures are based on recommendations from the state's Blue Ribbon Commission on Health Care Costs and Access. The legislation establishes the Health Insurance Partnership (HIP), modeled after Massachusetts' Commonwealth Connector.
As of September 2008, small businesses will be able to purchase health insurance through the HIP, which will provide premium subsidies on a sliding scale for employees with income below 200 percent of FPL (the subsidies will be available only if the firm obtains coverage through the HIP). The HIP's board will select at least four health plans to be offered to employees of participating small firms. The employees will have more choices than under a typical employer-sponsored plan, and employers will be spared much of the burden of administering the health plan. Many of the details—about rates, minimum requirements, plan benefits, and portability—will be determined by the board over the coming year.

In addition to the HIP purchasing pool, the state's health reform includes the following provisions:
• requiring all health insurers (and state employee programs) to allow members to extend coverage to unmarried children up to age 25;
• offering health promotion programs to state employees;
• encouraging electronic health records that give providers and patients access to their health information;
• modifying reimbursement rates to encourage prevention, better management of chronic conditions, and provision of effective care;
• establishing a quality forum to evaluate quality trends; and
• evaluating reinsurance options that address high-cost individuals.

[1] Engrossed Second Substitute Senate Bill 5930 and Engrossed Second Substitute House Bill 1569.

 For More Information
Contact: Beth Walter, Program Manager, Health Insurance Partnership, [email protected]

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