Washington Medicaid, SCHIP, & Federal Authority

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Deficit Reduction Act of 2005 (DRA)In June 2007, the Centers for Medicare and Medicaid Services (CMS) approved Washington’s submission of a benchmark state plan amendment under the DRA to offer Medicaid and disease management services to beneficiaries with certain chronic medical conditions. The chronic care coordination program, identifies high-risk and high-cost individuals with multiple chronic care needs and seeks to improve access and health outcomes while controlling costs.    Enrollment in the program is voluntary.[1] The program has two components:  a statewide care management program and a local care program.  In addition to state plan services, all enrollees receive condition-specific education; access to a nurse call line; care coordination including feedback to the primary care physician; and regularly-scheduled telephonic care management. All traditional Medicaid services will be administered on a fee-for-service basis, and a prepaid ambulatory health plan will provide the disease management.  

During the 2007 legislative session, Washington passed legislation to provide access to coverage for all children in the state by 2010.  Starting July 2007, it funds intensive education, outreach, and administrative simplification efforts to enroll all currently eligible children, covering over one-half of Washington 's uninsured children. Beginning in January 2009, the legislation authorizes the state to expand the State Children's Health Insurance Program (SCHIP) to children who have family incomes up to 300 percent FPL; the current eligibility level is 250 percent FPL. The department is authorized to seek federal financial participation for the expansion population. In addition, children in families with incomes above 300 percent FPL will have access to SCHIP at full-cost. Premiums would apply to children above 200 percent FPL. The legislation also includes a premium assistance program, if cost-effective, for those families with access to employer-sponsored insurance.


[1] All categorically needy aged, blind, or disabled adults ages 21 and over in Medicaid fee-for-service have the opportunity to enroll.