Washington State Seeks Federal Approval for ‘Groundbreaking’ Medicaid Proposal To Add Copayments, Cap Enrollment in Some Programs

Washington state -- which has "led the country in expanding optional Medicaid coverage" -- could "set a national precedent" if the federal government approves its application for a Medicaid waiver that would make some beneficiaries contribute copayments and cap enrollment in some programs, the AP/Baltimore Sun reports (AP/Baltimore Sun, 12/2). Under the state's current Medicaid program, individuals with annual incomes of up to 200% of the poverty level receive benefits. Beneficiaries with annual incomes below the federal poverty level ($8,590 for an individual and $17,650 for a family of four) receive mandatory coverage -- hospital care, doctor visits and in-home care. The state also extends mandatory services to beneficiaries with incomes above the poverty level. The waiver would affect optional, "nonmandatory" coverage, allowing the state to require beneficiaries below the poverty level to share the cost of services such as vision, dental, medications and medical equipment. People above the poverty level could to contribute monthly premiums and copays for those services, the Seattle Post-Intelligencer reports. If approved, the state could charge copayments and premiums totaling as much as 5% of some patients' incomes -- "significantly more than currently allowed." State officials say the waiver's goal would be to save money and "avoid cutting whole programs." If approved, the waiver would mean that "the health of the state budget -- not federal rules -- would help determine how the Legislature and governor fund Medicaid," the Post-Intelligencer reports.

Unique Requests
The waiver application is "unique" because it does not offer any expansion to the state's Medicaid program, the Post-Intelligencer reports. In addition, the waiver does not "offer specifics, such as how much any copayment might be" and instead requests "broad flexibility" to cut nonmandatory coverage. Critics are concerned that if the waiver is approved "some of the poorest" Washington residents could "lose access" to dental and vision care, prescription drugs, medical equipment and childhood health and development exams -- "or slip through the Medicaid safety net altogether" (Galloway, Seattle Post-Intelligencer, 11/30). Joan Alker, spokesperson for Families USA, said, "We think this would be a very, very dangerous and damaging path and precedent. It's really not about expanding coverage; it's about cutting the program." But Dennis Braddock, head of the Washington Department of Social and Health Services, said, "We have a lot of programs more important than health insurance. There are greater costs to society than someone not getting their physical" (AP/Baltimore Sun, 12/2).