Washington Medicaid Program

Washington Medicaid Program “Apple Health”

By Azka Amer

Table of Contents

1. Introduction

5. Medicaid Expansion

8. Funding

2. Federal/State Match Rate

6. Children's Health Insurance Program (CHIP)

9. Effectiveness of Program

3. Basic Benefit Plan

10. References

7. Physician Reimbursement and Availability

4. Traditional Income Requirements

Introduction

• Established in compliance with federal regulations
• Offers qualified people essential medical coverage and services
• Known as “Apple Health”
• Extending eligibility standards to cover people and families with incomes up to 138% of the federal poverty line
• The state's uninsured rate has significantly decreased as a result of this expansion, improving the state's inhabitants' health as well as financial stability
• New payment strategies, adjustments to reimbursement rates, and alterations to the healthcare delivery system

Federal/State Match Rate: FMAP is 70%

Basic Benefit Plan

mental health services including therapy and counseling

recipients get access to a variety of primary care services, such as doctor visits, preventative care, and vaccinations.

adult dental treatment

provides coverage for both inpatient and outpatient hospital care

vision care

rehabilitation therapies

prescription drugs

prenatal, maternity, and postpartum treatments

Traditional Income Requirements:

• Based on characteristics including family size, income, and other considerations, these criteria determined whether a person or family qualified for Medicaid.

• Medicaid was available to kids from low-income households: below 200% of the federal poverty limit (FPL) (Tomsic, 2022).

• Medicaid was also available to expectant mothers whose earnings were at or below 200% of the federal poverty level (FPL) both throughout the pregnancy and after delivery.

• Parents and caregiver relatives have more stringent eligibility requirements, with income thresholds frequently set at or below 50% of the FPL (Tomsic, 2022).

‘For assessing ACA eligibility, the state utilized the Modified Adjusted Gross Income (MAGI) technique. This method of calculating income streamlined the procedure, brought it into compliance with federal tax regulations, and made it simpler for people to comprehend and apply for Medicaid coverage.’

- (Kilduff, 2022)

Medicaid Expansion

VS

Before

After

• has made sure that more of its citizens have access to comprehensive healthcare services, preventative care, and treatment for chronic diseases
• the state's economy has benefited from Medicaid expansion
• federal assistance has boosted economic growth by generating jobs in the healthcare industry
• participants are more likely to obtain prompt medical attention, resulting in early health issue detection and treatment
• has lessened financial obstacles to healthcare, easing the burden of medical debt and bankruptcies linked to medical expenses for low-income people and families

• a large number of people with low incomes lacked access to:
• affordable health insurance,
• frequently reliant on expensive emergency department visits
• foregoing treatment entirely

Children's Health Insurance Program (CHIP): Apple Health for Kids

Children up to the age of 19 with qualifying families that fulfill the income and other eligibility standards are covered by Apple Health for Kids (NASHP Staff, 2019). It includes a wide array of fundamental medical services, such as hospital stays, doctor visits, dental work, eye exams, vaccinations, and mental health treatments.

A sliding scale is used to determine premiums and cost-sharing obligations, taking into account family income. Apple Health for Kids takes care of medical requirements as soon as they arise, which not only keeps kids healthy but also prevents long-term health problems

Physician Reimbursement and Availability

Reimbursement Rate

Access to Specialty Care

Payment Reforms

The state has created networks and collaborations with providers of specialized care in order to guarantee Medicaid clients are able to get to the appropriate specialized medical treatment when they are in need of it

To entice more healthcare providers to accept Medicaid patients, the state has recently raised Medicaid reimbursement rates

Health Home Program, which places a high priority on care coordination for patients with complicated medical requirements, including Medicaid beneficiaries.

Funding ...

FMAP

The FMAP in Washington generally runs from 50% to 74%, therefore Medicaid is funded by an equal amount of state as well as federal money.

Reverse of federal payments

The non-federal portion of Medicaid expenditures in Washington are covered in part by the state budget. In its yearly budgeting process.

Federal support

The ACA's authorization of Medicaid expansion has given Washington access to greater federal funding to provide healthcare for the increased population.

Effectiveness of Program

- mortality rates - the management of chronic illnesses - mental health - decline in the death rates - state-wide disorders of mental health - behavioral health care - receive treatment for addiction and mental illness

The quantity of uninsured people in Washington has drastically decreased as a result of this expansion. Data from the Washington State Health Care Authority show that the proportion of people without health insurance decreased from 14.5% in 2012 to just 5.7% in 2017

Two steps, the state, has taken to improve access are: 1. raising primary care physicians' pay rates 2. encouraging the use of tele health services + Programs like the Health Homes Program

• implemented payment adjustments and innovative strategies
• has switched to value-based payment models
• undertaken measures to mix mental as well as physical healthcare

Improved Health Outcomes

Payment Reforms and Efficiency

Expansion of Coverage

Access to Care

Thank you by Azka Amer

References

Federation of American Scientists. (2020). Medicaid’s Federal Medical Assistance Percentage (FMAP). https://sgp.fas.org/crs/misc/R43847.pdf

DeWalt, D. A., Oberlander, J., Carey, T. S., & Roper, W. L. (2005). Significance of Medicare and Medicaid Programs for the Practice of Medicine. Health Care Financing Review, 27(2), 79–90. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4194929/

Gencarelli, D. M. (2003). Medicaid Prescription Drug Coverage: State Efforts to Control Costs. In PubMed. National Health Policy Forum. https://www.ncbi.nlm.nih.gov/books/NBK559776/

NASHP Staff. (2019, December 5). Washington CHIP Fact Sheet. NASHP. https://nashp.org/washington-chip-fact-sheet/

Kilduff, L. (2022, January 31). How Poverty in the United States Is Measured and Why It Matters. PRB. https://www.prb.org/resources/how-poverty-in-the-united-states-is-measured-and-why-it-matters/

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