SB 5894: Relating to authorizing the Medicaid expansion while ensuring state financial protections, increasing consumer engagement and choice, and establishing expectations for improved health outcomes

Sponsored by Sen. Becker, SB 5894 states that if the federal medical assistance percentage for the expansion falls below 90%, the Health Care Authority will ensure that the state does not incur any additional costs above what would have been incurred had the federal authority remained at 90%. This may be accomplished through program adjustments including adding or adjusting premiums, modifying benefits, or reducing optional programs. The Authority is authorized to establish copayment, deductible, or coinsurance, or other cost-sharing requirements for recipients of medical programs, except that premiums may not be imposed on children in households at or below 138% of the federal poverty level (changed from 200%). Enrollees in the Medicaid expansion must be provided with a choice of plan consistent with the enrollment practices offered other enrollees processed by the health benefit exchange.  Contracts must incorporate accountability measure that monitor patient health and improved health outcomes, and may include an expectation that each patient receive a wellness examination that documents the baseline health status and allows for monitoring of health improvements and outcome measures. Contracts may allow plans to offer small incentives for enrollees to participate in prevention and wellness activities. The authority must develop contract performance measures that demonstrate meaningful measurement of enrollee health status and wellness, efforts by the managed care plan to increase enrollee participation in meaningful activities including a wellness visit, and application of evidence-based practices. The performance measures shall assist the authority and the legislature in monitoring managed care plan accountability and monitoring for limited access to appropriate care or fraud. The Authority must also complete a study on the integration of the behavioral health system, including mental health and chemical dependency services, into the medical purchasing.  Data must be gathered about Medicaid enrollees that may have dropped employer coverage. Potential crowd-out of employer coverage related to the expansion of Medicaid coverage will be monitored by WSIPP and included in their grant research.