Many Beneficiaries in Washington’s Health Plan for Low-Income Residents Have Incomes That Make Them Ineligible, Audit Says

Many of the Washington state residents enrolled in the state-subsidized Basic Health plan have annual incomes that make them ineligible for the program, according to the results of a state audit released last week, the Seattle Times reports (Ostrom, Seattle Times, 2/11). The Basic Health plan serves uninsured, low-income residents who do not qualify for Medicaid. Under the program, families earning up to 200% of the federal poverty level -- about $35,300 for a family of four -- can purchase health insurance on a sliding scale, with premiums for a family of four ranging from $20 to $119 per month (Kaiser Daily Health Policy Report, 5/19/01). Between June 2000 and July 2001, 130,978 residents received coverage through the plan; some 7,000 of those beneficiaries had reported to the state less income than what other sources showed and "clearly" should not have qualified for the program, state Auditor Brian Sonntag said. About 37,000 beneficiaries did not provide enough information to allow the state Health Care Authority, which administers the program, the authority to verify the annual incomes they reported, the audit says. According to Sonntag, the Health Care Authority does not confirm income eligibility at the time of enrollment, "[n]or does the authority effectively monitor" the incomes of beneficiaries over time. Sonntag added that some beneficiaries should be "paying higher premiums" than they currently are because they now have higher incomes. Sonntag said, "This is a serious condition. ... [T]here are likely a whole lot of folks eligible for these benefits out there who are not able to get them." According to state officials, about 11,000 people "who do qualify" for the program are on a waiting list. Dave Wasser, a spokesperson for the authority, said that by the end of the year, the authority plans to establish "policies and procedures and check the incomes of everyone on the program" (Seattle Times, 2/11).