High-Risk Pool

The Washington State Health Insurance Pool first became operational in 1988. The pool is financed through premiums and assessments to insurers. The premium cap is 150 percent of the standard risk rate in general but 125 percent for the Pool's preferred provider plan. At the end of 2006, approximately 3100 persons were enrolled in the program.

Limited-Benefit Plan

In 2004, Washington passed legislation redefining the small group market, changing group size to 2 to 50, from 1 to 50. The legislation also streamlines some administrative costs, protects portability of policies, and implements new rating factors for health insurance plans. Carriers are permitted to offer a limited- benefit package (replacing the previous requirement to offer a prescribed limited-benefit package that mirrored the Basic Health package.)

Dependent Coverage

Any commercial health plan offering health insurance coverage must allow the option of covering unmarried dependents up until age 25. Additional premiums may be charged to cover these young adult dependents. If the dependent meets certain disability criteria, parents may continue to cover the dependent irrespective of age for the same premium as dependents under age 20. These requirements also apply to the state employee program.

Other

Basic Health - Created in 1988, Basic Health (BH) is a state-sponsored program that provides health care coverage to Washington State residents with family incomes below 200 percent FPL. Monthly premiums are based on family size, income, age, and health plan choice, with a sliding scale state subsidy. Member cost-sharing comes in the form of copays, coinsurance, and deductibles. A standardized benefits package is offered through private insurance carriers offering a "managed care plan." To qualify, applicants must meet BH's income guidelines, live in Washington state, not be eligible for Medicare, not be a full-time student in the United States on a student visa, and not be institutionalized at the time of enrollment. As of Fall of 2006, the program covered approximately 100,000 subsidized enrollees. BH and Medicaid coordinate coverage to support family unity for low-income families. Close to 15,000 additional children receive coverage via BH and Medicaid covers approximately 22,000 children. Medicaid coverage is delivered through BH contracted health plans.

In addition, there are several small sub-programs included in BH and that are included in the total enrollment figure of approximately 100,000 subsidized BH enrollees. The "financial sponsors" program allows a third party to pay the BH premium. As of the Fall of 2006 about 28,000 BH enrollees had financial sponsors. Employers may also sponsor coverage for their employees who meet BH eligibility criteria. As of Fall of 2006, about 250 BH enrollees were enrolled in the employer-sponsored program. BH is also available to foster parents and homecare agency workers or individual providers employed by clients of the state's Medicaid Aging and Disability program.

Coverage for Non-Citizen Children - In January 2006, the Washington State Children's Health Program (CHP) was re-instated in Medicaid to provide health coverage for non-citizen children in families up to 100 percent of federal poverty. Funding has been provided to cover about 14,000 CHP enrollees. In addition, non-citizen children in families up to 200 percent of federal poverty may enroll in Basic Health.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.