wa-law.org > bill > 2023-24 > SB 5492 > Original Bill

SB 5492 - Health care afford./medicare


Section 1

  1. The legislature finds that:

    1. Medicare provides health coverage to adults 65 years of age and older, as well as people with disabilities, but it comes with significant out-of-pocket costs. Medicare enrollees pay premiums and cost-sharing for the services medicare covers and the full cost for the services that medicare excludes, including vision, dental, and hearing services. Half of low-income medicare enrollees with income at 200 percent of the federal poverty level spend 27 percent or more of their income on out-of-pocket health care costs;

    2. Lower income enrollees struggle with these costs and may defer or forgo care, with their health suffering as a result. In a recent survey of over 1,300 Washington residents, 75 percent of households that included a person with a disability and 32 percent of people over age 65 went without care in the last year due to cost. For example, 46 percent of households with a person with a disability did not fill a prescription, cut pills in half, or skipped a dose due to cost concerns;

    3. Compared to coverage available to younger people and people without disabilities, medicare enrollees in Washington get much more limited help with their health care costs and services;

      1. A medicare enrollee can stay on medicaid only if their income is below about 75 percent of the federal poverty level, compared to 138 percent of the federal poverty level for a younger person or a person without a disability. This means that when a person who is living at the poverty level turns 65, they lose their access to affordable, comprehensive health coverage;

      2. Medicare savings programs are joint federal-state programs that help enrollees with the cost of premiums, cost sharing, and prescription drug costs. Current standards for these programs in Washington are at the lowest level permitted by federal law;

    4. Other states have taken steps to expand the programs that help medicare enrollees with health costs, with some states harmonizing eligibility for medicaid and others expanding access to medicare savings programs. For example, California and New York recently raised income limits for medicaid to 138 percent of the federal poverty level, and Massachusetts has raised income limits for medicare savings programs to 226 percent of the federal poverty level.

  2. The legislature therefore intends to take a step toward parity in access to affordable health care by expanding the availability of medicare savings programs, in order to provide premium and cost-sharing assistance to an estimated 50,000 or more older adults and people with disabilities, helping them to afford the health care they need to thrive.

Section 2

  1. The authority shall offer eligible clients the following medicare savings programs:

    1. The qualified medicare beneficiary program;

    2. The specified low-income medicare beneficiary program;

    3. The qualified individual program; and

    4. The qualified disabled and working individuals program.

  2. To be eligible for a medicare savings program, a client must be entitled to medicare part A and meet other eligibility requirements established by the authority and federal law.

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    1. A client is income eligible for the qualified medicare beneficiary program if the client's countable income is less than or equal to 138 percent of the federal poverty level.

    2. The authority may establish by rule income limits higher than the federally required minimum levels for the qualified medicare beneficiary program and other medicare savings programs. The authority shall seek to maximize the availability of the qualified individual program through the centers for medicare and medicaid services.

    3. The medicare savings programs may not require a resource test.

  4. The authority may adopt any rules necessary to administer this section. Nothing in this section may be interpreted to limit the authority's existing rule-making authority related to medicare savings programs.

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