This year’s Washington Legislature enacted many bills that are intended to improve access to health care – perhaps an unprecedented number – and much other health legislation. We saw progress in improving access to care, including added coverage for immigrants, an effort to address insurance affordability, and bills to advance health equity. Some session highlights, with links to our previous blog posts, are:

Protecting Washington from erosion of the ACA and other health equity provisions:

• By incorporating several key provisions of the federal Affordable Care Act of 2010 into Washington State law, our state now has its own basis for protecting individuals with pre-existing conditions and those needing care from discrimination by insurers. See our blog post on HB 1870.
• Extending and improving Maternal Mortality Review to include impacted populations. See our blog post on HB 5425.
• Enhancing health equity by prohibiting discrimination that many transgender and gender-nonconforming people face in receiving reproductive health care services; requiring student health plans to cover reproductive health services; mandating that hospitals be transparent about their policies related to admission, nondiscrimination, and the reproductive health services available at the hospital; and requiring the Bree Collaborative to establish guidelines with clinical recommendations to improve reproductive health care for people of color, immigrants and refugees, gender-based violence survivors, and people with disabilities. An expansion of family planning coverage to immigrants, discussed in our previous blog post on SB 5602, was not in the final bill, and included only in a budget proviso. See the first item below.

Apple Health Expansions.

The state will invest in:

• Expanding Family Planning coverage to immigrants (through a budget proviso) to provide coverage for immigrants who are currently ineligible for Medicaid, Affordable Care Act Qualified Health Plans, or “Take Charge,” the state’s Family Planning Program. The covered benefits are reproductive health services equivalent to those offered under Take Charge and include all FDA approved contraceptive methods. Enrollees must have income no greater than 260% of FPL, like Take Charge.
• Removing barriers to Health Care for Workers with Disabilities Medicaid coverage so individuals trying to work at maximum capacity don’t lose it. The program requires paying premiums based on income, and has no resource limit. The legislature eliminated the income limit and age limit (currently 65), and directed the state to seek federal Medicaid agency approval for workers to keep savings from their earnings if they must switch later to a different Medicaid program with resource limits. See our blog post on HB 1199.
• Adding dental coverage for many low-income immigrants who can’t qualify for Medicaid: beginning January 2020 for people who get Medical Care Services because they are either incapacitated from working or over 65, and beginning January 2021 for citizens of the Compact of Free Association (COFA) Pacific Island nations of Micronesia, the Marshall Islands, and Palau, whose Qualified Health Plan medical premiums the state subsidizes .

Creating a first-in-the-nation program to pay for long term services and supports.

Washington workers will pay for the program with payroll deductions starting in 2022. Workers regardless of income who paid in for specific numbers of years and need help with a least three Activities of Daily Living” can begin receiving benefits (365 units of $100 each) no earlier than 2025.  See our blog post on HB 1087.

Individual Health Insurance.

Senate Bill 5526, dubbed “Cascade Care,” was a highly-publicized bill this session, sponsored by House Health Committee Chair Eileen Cody, to address affordability in the individual insurance market. The bill contains a number of provisions with this goal:

• First, it requires the Exchange to define standardized gold, silver, and bronze level plans. Insurance carriers must have a standardized plan at each level that they offer plans, so that consumers can better compare plans.
• Second, beginning in 2021, the state will contract directly with at least one carrier for standardized plans that meet new affordability, care coordination, and other criteria, including limits on reimbursement to health care providers and facilities. NoHLA’s advocacy was critical to requiring that these contracts include bronze as well as gold and silver level plans. This was necessary because without state-purchased bronze plans, lower-income bronze enrollees might have experienced a jump in premiums. It is hoped that the state-purchased plans will rein in premiums by five to ten percent. This will primarily impact enrollees in the Exchange who have incomes over 400% of the poverty level, as lower-income enrollees are likely to see their tax credits reduced, offsetting premium reductions. However, we won’t know for sure what the impact of state-offered Qualified Health Plans will be until the state negotiates its contracts with the insurance carriers.
• Third, by November 2020, the Health Benefit Exchange and Health Care Authority must develop a plan to subsidize premiums and reduce cost-sharing for Washingtonians with income up to 500% of the federal poverty level. See our blog post on SB 5526. As advocates for greater affordability of coverage for households with limited income, NoHLA hopes to be involved in the planning process.

Eliminating Surprise Medical Bills.

After years of effort, legislation made it across the finish line this session to protect Washingtonians who rely on private health insurance from surprise (often shocking) medical bills. Thanks to House Bill 1065, a bill requested by the Insurance Commissioner, sponsored by Representative Cody, and supported by consumer advocates, patients will now be protected from being billed for out-of-network care during an emergency hospitalization or when receiving care at a facility within their insurance plan’s network. This legislation takes the patient out of the middle of billing disputes between insurers and providers by creating a resolution process between them. For emergency services provided in neighboring states, the legislation will defer to those states’ laws, to any interstate compact, or any federal legislation. The surprise billing protections take effect January 1, 2020. The new law applies to people insured by carriers regulated by the state and to public employees, but other plans (self-funded group health plans) may also choose to participate. For more information, see our blog post on HB 1065. NoHLA Executive Director Janet Varon and Volunteer Attorney David Roth were pleased to be present at the signing of the bill this week; see OIC’s press release here.

Work group for universal health care.

The Legislature directed the Health Care Authority to convene a workgroup on establishing a universal health care system in Washington. The work group is to make recommendations regarding how to create, implement, maintain, and fund a universal health care system that may include publicly funded, publicly administered, and publicly and privately delivered health care that is sustainable and affordable to all Washingtonians. It is to consist of a broad range of stakeholders with expertise in the health care financing and delivery system, including consumers, patients and advocates, many other stakeholders and agencies, and legislators from each caucus (Democratic and Republican) of the House and Senate. The formation of the workgroup is underway. The complete proviso is in the budget bill, page 134.

Access to care through your insurance plan.

A sad and compelling story led the Legislature to take a step toward ensuring that individuals can actually access the care promised by their insurance plan. See our blog post on HB 1099. The bill, sponsored by Representative Laurie Jinkins, is aimed at improving information and resources for individuals trying to access mental health and chemical dependency treatment. It will be known as Brennen’s law in memory of the young man whose story was the impetus for the bill.

The new law requires health insurance carriers to note on their electronic provider directories when a mental health or substance abuse provider is closed to new patients. And, starting on January 1, 2020, carriers must also prominently post on their website in an easily understandable format, and in a manner by which any interested party may obtain the following information:

• Whether the carrier classifies mental health and substance abuse treatment as primary or specialty care, and the number of business days within which an enrollee must have access to covered mental health and substance abuse services (as required by the Insurance Commissioner’s network access standards).
• What actions enrollees may take if they are unable to access care within the requisite number of business days, including any tools or resources the carrier makes available to assist enrollees in finding available providers, and information about how to file a complaint with the Insurance Commissioner.
• Any instances where the Commissioner has taken disciplinary action against the health carrier for failure to comply with network access standards for covered mental health/substance abuse treatment services.
• Resources for persons who are experiencing a mental health crisis, including information on the national suicide prevention hotline https://suicidepreventionlifeline.org/.
• A link to the Commissioner’s annual report, required by this law, on the number of consumer complaints received per licensed health carrier, regarding consumers who were not able to access mental health/substance abuse treatment services within the required time limits.

We will be monitoring the carriers’ and Insurance Commissioner’s implementation of this law. If you or someone you know is having difficulty accessing mental health or substance abuse treatment, please direct them to their insurance carrier’s website for the information specified above. If it is not comprehensive or easy to find, please contact the Insurance Commissioner’s office and consider filing a complaint. And please let us know as well (nohla@nohla.org).

Behavioral Health.

New laws address the opioids public health crisis (SB 5380), implement recommendations of the state children’s mental health workgroup (SB 5903 and HB 1874), addresses behavioral health workforce issues (HB 1768, HB 1907, and SB 5054), provide for completing integration of behavioral Medicaid managed care (SB 5432), expand and create new community-based treatment facilities (HB 1394), and reform evaluation and restoration of competency for people charged with crimes, as required by a federal court order (SB 5444). See the BEHAVIORAL HEALTH, MENTAL HEALTH, AND SUBSTANCE USE DISORDERS section of our 2019 Legislative Summary.

Public Health.

The Legislature also raised the minimum age for tobacco smoking and vaping to 21 (HB 1074), implemented recommendations of a pesticide application safety work group (SB 5550), and in the wake of a measles outbreak, eliminated the personal or philosophical exemption from the Measles, Mumps, and Rubella vaccination requirement for students. See the PUBLIC HEALTH section of our 2019 Legislative Summary and our blog post on HB 1638.

Please join us in thanking the health care leaders in the Legislature who moved these and other bills to the finish line!

Budget cloud on the horizon.

NoHLA is seriously concerned that the operating budget assumes that the Health Care Authority can save over $350 million in the Medicaid program by implementing “program integrity” recommendations from the federal Medicaid agency. See NoHLA’s 2019 Budget Summary. The Health Care Authority and a broad coalition including NoHLA gave the Legislature several reasons for considering those projected savings entirely unrealistic. The federal agency does not estimate specific savings from its recommended strategies, which our state and the managed care organizations already largely employ. NoHLA and advocate partners will have to be vigilant that the state does not pursue eligibility or service cuts to fill the gap it’s creating.