WASHINGTON JOINS STATES LOOKING TO INSURE ALL KIDS
Volume 28, Issue 487 March 19, 2007
Anna C. Spencer
Washington has joined the growing list of states that are working to expand health insurance coverage to all children in the state.
On March 13, Washington Governor Christine Gregoire signed a multifaceted bill that aims to increase the number of children in the state with health coverage, establish medical homes, improve the quality of care for children, and invest in outreach and healthy school environments.
Proponents of the legislation hail it as an “historic vote” for children, but critics argue that the program diverts money from taxpayers and the poorest citizens to cover illegal immigrants and too many middle-class families.
Under the new law, the state will expand health coverage for children under the age of 19 in families earning up to 250 percent of the federal poverty level (FPL)—roughly $50,000 for a family of four—regardless of immigration status. The move is expected to provide health insurance for an additional 38,000 of the state’s 73,000 uninsured children. Coverage will be free to those earning under 200 percent of the FPL. Families earning 200 to 250 percent of poverty will be required to help pay monthly premiums based on a sliding scale.
The legislation is unusual in that it will create a single eligibility standard, irrespective of income or immigration status. Washington currently operates three subsidized health insurance programs for children: Medicaid, the State Children’s Health Insurance Program and the Children’s Health Program, which provides coverage to non-citizen children in families earning up to 100 percent of the FPL. The bill calls on the Department of Social and Health Services (DSHS) to develop a streamlined eligibility determination and renewal procedure in order to “remove the barriers to coverage posed by three different application procedures,” said Christina Hulet, executive health policy advisor with the Governor’s office. “The current system prevents a lot of children from gaining access to coverage,” Hulet said.
Representative Lynn Kessler responds to critics who argue that the legislation takes away from legal residents by saying that the state pays for health care for these children anyway, and generally in more expensive settings. “We know we are paying for these kids in emergency departments, often when their illness is at a later stage and more expensive to treat,” she said. “It’s a moral issue, as well as a cost issue.”
The estimated 2007-2009 biannual cost of covering kids under the three programs is roughly $680 million in state and federal funds. The new law will cost the state an additional $30 million in the first two years of operation; funds will come from state general revenues.
In addition, the legislation requires that children enrolled in government-subsidized health programs have a “medical home.” The DSHS—in collaboration with health plans, local public health jurisdictions, children's health care providers, parents, and other purchasers and providers—will be required to identify explicit performance measures to indicate that a child has a medical home. Performance measures will include childhood immunization rates; well child care utilization rates, including the use of valid developmental assessment tools that include behavioral and oral health screening; care management for children with chronic illnesses; emergency room utilization; and preventive oral health service utilization. “The concept of the legislation was to take a comprehensive approach to children’s health by ensuring that insurance coverage translated into better health,” said Hulet. “The medical home will serve that end.”
Reaching Higher
Down the road, the legislation also calls for extending public health insurance coverage to even more children. Starting January 2009, children in families earning up to 300 percent of the FPL (roughly $60,000 for a family of four) will become eligible for state-subsidized health insurance coverage. Families earning more than 300 percent of the FPL will be allowed to purchase health insurance for their children without any premium assistance from the state, but they’ll be pay the same monthly rate as the state pays to cover kids under the unified plan.
The bill stems from the Healthy Washington Initiative, a plan developed by the Governor and recommendations from The Blue Ribbon Commission, convened by the Governor, to increase and improve access to care. The initiative aims to ensure that all the state’s children have access to health care by 2010; that all Washingtonians have access to health-care coverage by 2012; to make Washington one of the top ten healthiest states in the nation; and to ensure that the rate of health-care spending does not exceed the rate of growth in personal income.
© Copyright 2007, State Health Notes
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