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National Academy for State Health Policy

20th Annual State Health Policy Conference

Covering All Kids WorkshopOctober 16, 2007

Washington StateDepartment of Social

& Health Services

Roger Gantz, DirectorLegislative & Policy Health and Recovery Services AdministrationDepartment of Social and Health ServicesState of Washington

623 8th Avenue S.E.P.O. Box 45502Olympia, Washington 98505-5502(360) 725-1880Email: gantzrp@dshs.wa.gov

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Washington StateDepartment of Social

& Health Services

Topics

•Washington’s Subsidized Coverage for Children

•Health Care Services for All Children (SSB 5093)

•Employer-Sponsored Insurance Program

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Washington StateDepartment of Social

& Health Services

Washington State’s Subsidized Coverage for Children

Washington has been a national leader in providing health coverage for children.

•August 1989 – Coverage for pregnant women and infants in families up to 185% FPL.

•January 1991 – Coverage for all children in families up to 100% FPL.

•January 1992 – Coverage for citizens converted to Medicaid and age increased to 19.

•January 1992 – Target fee increases for maternity services and children’s office visits.

•1993 – Statewide implementation of Healthy Options (HO) managed care program – Coverage for non-SSI children, families and pregnant women.

•July 1994 – Coverage for citizen children increased to 200% FPL.

•February 2000 – SCHIP implemented with coverage to 250% FPL.

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Washington StateDepartment of Social

& Health Services

Washington State’s Subsidized Coverage for Children

State Subsidized Health Coverage(June 2007)

  Number %Total

Medicaid    

- Children's Medical Program 352,437 61.4%

- Family (TANF) Medical Program 164,079 28.6%

- Disabled Children 17,592 3.1%

- Pregnant Women 2,461 0.4%

  536,569 93.5%

     

SCHIP 10,414 1.8%

     

Children's Health Program 14,037 2.4%

     

Basic Health Program 13,012 2.3%

     

Total 574,033 100.0%

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Washington StateDepartment of Social

& Health Services

2SSB 5093 (Health Care Services for Children)

• New consolidated health program for children - merges Medicaid, SCHIP and Children’s Health Program (CHP).

• Benefit design is full-scope Medicaid. Premiums for families with incomes above 200% of FPL ($41,300 for family of four). 12-month continuous eligibility coverage.

• July 22, 2007, state subsidized coverage available to all children in families up to 250% of FPL ($51,635 for family of four). Entitlement status.

• January 2009, state subsidized coverage expanded to 300% of FPL ($61,950 for family of four). Non-entitlement status. Families with higher incomes can buy coverage on a full-cost basis.

• Simplification of applications and renewal process, implementation of new on-line application process.

• Develop performance measures. Beginning in calendar year 2009, targeted provider rate increases to be linked to quality improvement measures.

• $63 million for SFY 2008-09 to cover 38,500 new children, including $4.4 million for new targeted outreach and health education.

• Pediatric services increased 48% (approx 90% of commercial) to support medical home.

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Washington StateDepartment of Social

& Health Services

2SSB 5093 (Health Care Services for Children)

Drop headline:

• Text text

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Children Covered through State-Financed Health Programs

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Governor's eligibility policy implemented

Actuals

Feb07 Primary Trend Forecast

2SSB 5093 Policy Step (38,5000 children)

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Washington StateDepartment of Social

& Health Services

Medicaid Employer-Sponsored Insurance Program

• Washington’s Medicaid employer-sponsored insurance (ESI) program is a voluntary program. 1

• ESI eligibility – Medicaid-eligible, no other premium assistance, and not eligible for Medicare or state’s Basic Health Program.

• Person enrolled in ESI if they have access to employer-sponsored insurance and it is cost effective.

• Cost effectiveness guideline: employee’s premium contribution compared to age/gender adjusted Medicaid per-capita cost.

• ESI program directly reimburses family for employee’s premium contribution for family member covered through ESI, and not the employer.

• Medicaid covers wraparound services not covered by employer coverage. Point-of-service cost-sharing also covered.

• Pilot Medicaid employer-sponsored insurance (ESI) program implemented September 2004. Full program began July 2005.

• June 07 enrollment – 2,000, approx. 95% of ESI clients are children.

1 Pilot implemented under authority of Section 1906 of the Social Security Act.

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Washington StateDepartment of Social

& Health Services

Medicaid Employer-Sponsored Insurance Program

Medicaid Employer-Sponsored Insurance (ESI) Program - Enrollment

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Washington StateDepartment of Social

& Health Services

Medicaid Employer-Sponsored Insurance Program

Revisions to support ESI Enrollment

•2007 state legislation requiring state regulated health insurance coverage to allow for Medicaid clients to enroll in employer-sponsored health plan without regard to any open enrollment restrictions (2SSB 5093, Sec. 7 and E2SSB 5930, Sec. 24)

• (Note: Neither ESSB 5930 or existing Medicaid law preempts ERISA)

•2007 legislation requiring families, to extent permitted under federal law, to enroll in available employer-sponsored insurance as a condition of eligibility for Medicaid (2SSB 5093, Sec.2(4)).

•ESI has begun sending information to new Medicaid clients upon enrollment.

•Marketing to employers about ESI program.

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Washington StateDepartment of Social

& Health Services

Medicaid Employer-Sponsored Insurance Program

ESI Program Contact

Norma Leavitt, Program ManagerEmployer Sponsored Insurance ProgramDepartment of Social and Health ServicesHealth and Recovery Services AdministrationP.O. Box 45518Olympia, Washington 98504-5518

Telephone: 1-800-794-4360, ext. 51355FAX: 1-877-893-3810E-Mail: leavind@dshs.wa.gov