wa-law.org > bill > 2025-26 > HB 1482 > Original Bill
The legislature finds the following:
Washington is home to more than 1,000,000 immigrants who strengthen the state's economy, attend school, work, and pay taxes, but are structurally excluded from the social safety net;
Individuals with health insurance coverage have better health outcomes than those who lack coverage. Uninsured individuals are more likely to be in poor health and more likely to delay or forego needed health care services, which ultimately drives up the cost of care;
Federal law unjustly excludes certain categories of immigrants from receiving affordable health coverage. As a result, immigrants are disproportionately uninsured and at risk for poor health outcomes. In 2021, undocumented immigrants had an uninsured rate six times that of United States citizens;
Washington has a long history of working toward equity in immigrant health coverage. The state's basic health program covered low-income residents without regard to immigration status until it was dismantled in anticipation of affordable care act reforms which have proven to be insufficient in addressing the disparity in coverage. By contrast, the state's "cover all kids" law was retained and continues to be successful in reducing immigration-related inequity among Washington's children. In recent years, the Washington state legislature has worked to fill this gap by funding apple health expansion for fiscal year 2025 and by providing state subsidies that have been accessible to immigrant community members through the purchase of health insurance through Washington's Cascade care savings program; and
There are remaining opportunities for the state to seek federal flexibility to cover immigrants otherwise excluded from federal health programs, including funding apple health expansion to cover all income-eligible persons and subsidize qualified health and dental plans to bring their costs into parity with the affordable care act subsidized plans.
The legislature intends to:
Improve the health of all people in the state by extending health coverage options at parity to all Washington residents, regardless of immigration status, by:
Codifying a state medicaid equivalent program which is accessible at no cost to people who meet income eligibility standards for federal medicaid or federal insurance affordability programs, except for their immigration status; and
Extending financial assistance for qualified health plans and qualified dental plans for enrollees who are ineligible for federal advance premium tax credits due to federal immigration status restrictions.
Work towards equity in providing culturally diverse and linguistically appropriate care through these programs.
The apple health expansion program is established. Under the program, the authority shall provide health coverage to individuals who:
Are at least 19 years old;
Have a countable income that is at or below 138 percent of the federal poverty level, adjusted for family size and determined annually by the federal department of health and human services using the modified adjusted gross income methodology; and
Are ineligible for federal assistance affordability programs, including medical assistance, as defined in the social security Title XIX state plan, and federal advance premium tax credits, due to immigration status restrictions.
The amount, scope, and duration of health care services provided to individuals under this section must be no less than, and the cost of coverage for those health care services must be no more than, that provided to individuals eligible for categorically needy medical assistance, with the exception of long-term services and supports.
The authority shall use the same eligibility, enrollment, and appeals procedures as those used for categorically needy medical assistance, except where flexibility is necessary to maintain privacy or minimize burden to applicants or enrollees.
The authority shall manage its application and renewal procedures to maximize enrollment of eligible individuals, including assuring a seamless transition for individuals losing eligibility for other coverage, including child, pregnancy and postpartum, or emergency coverage.
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The authority shall establish the community accountability committee for apple health expansion. The community accountability committee shall adopt a charter establishing its scope of work, structure, limitations, and responsibilities. The authority shall provide administrative and research support to the committee.
The committee shall consist of at least five and no more than nine geographically diverse members. The majority of the members must be either representatives of community-based organizations working directly with enrollees of the apple health expansion program or enrollees of the apple health expansion program themselves. The remaining committee members may be either service providers from the apple health expansion program or representatives of organizations working with or supporting the program. Members may not have a conflict of interest with managed care organizations or their affiliated entities. A chair shall be selected from the members of the committee by a majority vote of the committee. After the initial members are appointed, vacancies must be filled with the mutual agreement of the committee members and the agency. The committee is a class one group under RCW 43.03.220 and eligible committee members shall receive stipends in accordance with that section.
The committee shall monitor the performance of managed care organizations and provide recommendations to the authority to maximize accountability to enrollees and the community-based organizations that support the enrollees. The authority shall incorporate the recommendations of the committee into contracting activities, state plan amendments, and enforcement activities. The committee shall focus on the effectiveness of services, quality of outcomes, and contractual compliance of the managed care organizations providing services under the program. The committee must have ready access to data to gauge managed care organization system performance, including enrollee demographic information, language access service utilization data, grievance and complaint data, and information regarding contract noncompliance.
The committee shall submit a report to the appropriate committees of the legislature and the office of financial management with recommendations from the committee regarding opportunities to maximize accountability to the community in contracting and contractual compliance by July 1, 2026, and every two years following.
The authority shall submit a report to the appropriate committees of the legislature and the office of financial management on the status and cost of the phased-in services described in this section by July 1, 2026. The authority may contract with consultants and partner with other agencies, as needed, to develop these reports.
The authority shall adopt rules to implement this section.
The exchange, in collaboration with the authority, shall establish and maintain a culturally and geographically diverse and linguistically appropriate immigrant health coverage outreach and education campaign, including direct support to community-based partners. For the purposes of the campaign, direct support is established by providing funding directly to community-based organizations, rather than third-party contractors and consultants, that: (1) Serve impacted communities by providing services directly to immigrant and refugee communities; and (2) are able to demonstrate a direct link to individual impacted community members. The campaign shall continue until there is parity between insurance coverage rates for immigrants and citizens.
The Washington health benefit exchange is established and constitutes a self-sustaining public-private partnership separate and distinct from the state, exercising functions delineated in chapter 317, Laws of 2011. By January 1, 2014, the exchange shall operate consistent with applicable federal law subject to statutory authorization. The exchange shall have a governing board consisting of persons with expertise in the Washington health care system and private and public health care coverage. The membership of the board shall be appointed as follows:
Each of the two largest caucuses in both the house of representatives and the senate shall submit to the governor a list of five nominees who are not legislators or employees of the state or its political subdivisions, with no caucus submitting the same nominee.
The nominations from the largest caucus in the house of representatives must include at least one employee benefit specialist;
The nominations from the second largest caucus in the house of representatives must include at least one health economist or actuary;
The nominations from the largest caucus in the senate must include at least one representative of health consumer advocates;
The nominations from the second largest caucus in the senate must include at least one representative of small business;
The remaining nominees must have demonstrated and acknowledged expertise in at least one of the following areas: Individual health care coverage, small employer health care coverage, health benefit plan administration, health care finance and economics, actuarial science, or administering a public or private health care delivery system.
The governor shall appoint two members from each list submitted by the caucuses under (a) of this subsection. The appointments made under this subsection (1)(b) must include at least one employee benefits specialist, one health economist or actuary, one representative of small business, and one representative of health consumer advocates. The remaining four members must have a demonstrated and acknowledged expertise in at least one of the following areas: Individual health care coverage, small employer health care coverage, health benefit plan administration, health care finance and economics, actuarial science, or administering a public or private health care delivery system.
The governor shall appoint a ninth member to serve as chair. The chair may not be an employee of the state or its political subdivisions. The chair shall serve as a nonvoting member except in the case of a tie.
The following members shall serve as nonvoting, ex officio members of the board:
The insurance commissioner or his or her designee; and
The administrator of the health care authority, or his or her designee.
Initial members of the board shall serve staggered terms not to exceed four years. Members appointed thereafter shall serve two-year terms.
A member of the board whose term has expired or who otherwise leaves the board shall be replaced by gubernatorial appointment. Upon the expiration of a member's term, the member shall continue to serve until a successor has been appointed and has assumed office. When the person leaving was nominated by one of the caucuses of the house of representatives or the senate, his or her replacement shall be appointed from a list of five nominees submitted by that caucus within thirty days after the person leaves. If the member to be replaced is the chair, the governor shall appoint a new chair within thirty days after the vacancy occurs. A person appointed to replace a member who leaves the board prior to the expiration of his or her term shall serve only the duration of the unexpired term. Members of the board may be reappointed to multiple terms.
No board member may be appointed if his or her participation in the decisions of the board could benefit his or her own financial interests or the financial interests of an entity he or she represents. A board member who develops such a conflict of interest shall resign or be removed from the board.
Members of the board must be reimbursed for their travel expenses while on official business in accordance with RCW 43.03.050 and 43.03.060. The board shall prescribe rules for the conduct of its business. Meetings of the board are at the call of the chair.
The exchange and the board are subject only to the provisions of chapter 42.30 RCW, the open public meetings act, and chapter 42.56 RCW, the public records act, and not to any other law or regulation generally applicable to state agencies, except the exchange shall maintain immigration and citizenship status information restrictions as if it were a state agency subject to RCW 43.17.425. Consistent with the open public meetings act, the board may hold executive sessions to consider proprietary or confidential unpublished information.
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The board shall establish an advisory committee to allow for the views of the health care industry and other stakeholders to be heard in the operation of the health benefit exchange.
The board may establish technical advisory committees or seek the advice of technical experts when necessary to execute the powers and duties included in chapter 317, Laws of 2011.
Members of the board are not civilly or criminally liable and may not have any penalty or cause of action of any nature arise against them for any action taken or not taken, including any discretionary decision or failure to make a discretionary decision, when the action or inaction is done in good faith and in the performance of the powers and duties under chapter 317, Laws of 2011. Nothing in this section prohibits legal actions against the board to enforce the board's statutory or contractual duties or obligations.
In recognition of the government-to-government relationship between the state of Washington and the federally recognized tribes in the state of Washington, the board shall consult with the American Indian health commission.
Subject to the availability of amounts appropriated for this specific purpose, a premium assistance and cost-sharing reduction program is hereby established to be administered by the exchange.
Premium assistance and cost-sharing reduction amounts must be established by the exchange within parameters established in the omnibus appropriations act. In determining such amounts, the exchange shall prioritize reaching parity in financial assistance for enrollees, regardless of immigration status, by January 1, 2028, such that the total amount of premium assistance and cost-sharing reductions available to individuals eligible for federal advance premium tax credits is equivalent to those who are ineligible due to federal immigration status restrictions. The exchange shall submit a report to the relevant committees of the legislature and the office of financial management on the status and cost of such parity by November 1, 2025.
The exchange must establish, consistent with the omnibus appropriations act:
Procedural requirements for eligibility and continued participation in any premium assistance program or cost-sharing program established under this section, including participant documentation requirements that are necessary to administer the program; and
Procedural requirements for facilitating payments to carriers.
Subject to the availability of amounts appropriated for this specific purpose, an individual is eligible for premium assistance and cost-sharing reductions under this section if the individual:
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Is a resident of the state;
Has income that is up to an income threshold determined through appropriation or by the exchange if no income threshold is determined through appropriation;
Is enrolled in a silver or gold standard plan offered in the enrollee's county of residence;
Applies for and accepts all federal advance premium tax credits for which they may be eligible before receiving any state premium assistance;
Applies for and accepts all federal cost-sharing reductions for which they may be eligible before receiving any state cost-sharing reductions;
Is ineligible for minimum essential coverage through medicare, a federal or state medical assistance program administered by the authority under chapter 74.09 RCW, or for premium assistance under RCW 43.71A.020; and
Meets any other eligibility criteria established by the exchange; or
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The exchange may disqualify an individual from receiving premium assistance or cost-sharing reductions under this section if the individual:
No longer meets the eligibility criteria in subsection (4) of this section;
Fails, without good cause, to comply with any procedural or documentation requirements established by the exchange in accordance with subsection (3) of this section;
Fails, without good cause, to notify the exchange of a change of address in a timely manner;
Voluntarily withdraws from the program; or
Performs an act, practice, or omission that constitutes fraud, and, as a result, an issuer rescinds the individual's policy for the qualified health plan.
The exchange must develop a process for an individual to appeal a premium assistance or cost-sharing assistance eligibility determination from the exchange.
Prior to establishing or altering premium assistance or cost-sharing reduction amounts, eligibility criteria, or procedural requirements under this section, the exchange must:
Publish notice of the proposal on the exchange's website and provide electronic notice of the proposal to any person who has requested such notice. The notice must include an explanation of the proposal, the date, time, and location of the public hearing required in (b) of this subsection, and instructions and reasonable timelines to submit written comments on the proposal;
Conduct at least one public hearing no sooner than 20 days after publishing the notice required in (a) of this subsection; and
Publish notice of the finalized premium assistance or cost-sharing reduction amounts, eligibility criteria, or procedural requirements on the exchange's website and provide the notice electronically to any person who has requested it. The notice must include a detailed description of the finalized premium assistance or cost-sharing reduction amounts, eligibility criteria, or procedural requirements and a description and explanation of how they vary from the initial proposal.
The definitions in this subsection apply throughout this section unless the context clearly requires otherwise.
"Advance premium tax credit" means the premium assistance amount determined in accordance with the federal patient protection and affordable care act, P.L. 111-148, as amended by the federal health care and education reconciliation act of 2010, P.L. 111-152, or federal regulations or guidance issued under the affordable care act.
"Income" means the modified adjusted gross income attributed to an individual for purposes of determining his or her eligibility for advance premium tax credits.
"Standard plan" means a standardized health plan under RCW 43.71.095.
The exchange, in close consultation with the authority and the office of the insurance commissioner, must explore all opportunities to apply to the secretary of health and human services under 42 U.S.C. Sec. 18052 for a waiver or other available federal flexibilities to:
Receive federal funds for the implementation of the premium assistance or cost-sharing reduction programs established under RCW 43.71.110;
Increase access to qualified health plans;
Implement or expand other exchange programs that increase affordability of or access to health insurance coverage in Washington state; and
Improve affordability and benefits for lawfully present immigrants with a countable income that is at or below 138 percent of the federal poverty level, up to and including transitioning such individuals to the state program established in section 2 of this act through a waiver, with accompanying federal pass-through funds, if available.
If, through the process described in subsection (1) of this section, an opportunity to submit a waiver is identified, the exchange, in collaboration with the office of the insurance commissioner and the health care authority, may develop an application under this section to be submitted by the health care authority. If an application is submitted, the health care authority must notify the chairs and ranking minority members of the appropriate policy and fiscal committees of the legislature.
Any application submitted under this section must meet all federal public notice and comment requirements under 42 U.S.C. Sec. 18052(a)(4)(B), including public hearings to ensure a meaningful level of public input.