Dear Honorable Members of the House Ways & Means Committee

February 1, 2010

Dear Honorable Members of the House Ways & Means Committee

Re: House Bill 3048

The organizations signed onto this letterhave shared concerns about HB 3048, amending RCW 74.09 to allow another agency—likely the Health Care Authority (HCA) —to administer Washington’s Medicaid program as well as other state-funded medical programs. However, we recognize that there are potential benefits from the proposal to reorganize the agency arrangements for the purchase of health care by the state. The issues raised in this letter are advanced along with an offer to work with the Legislature, the Governor and the effected departments to facilitate improvements in the health care system. We also recognize that there could be an increasing need for coordination among agencies purchasing health care if the national health care debate creates an exchange where subsidies are administered.

The Department of Social and Health Services (DSHS) has administered Medicaid since shortly after the program’s inception, along with Washington’s other federally matched and state-only low-income medical programs other than Basic Health. DSHS also administers cash, food, child care, foster care, and a variety of other programs, and clients can currently apply for all cash, food and medical programs that DSHS offers through a single application. The Health Care Authority currently administers Basic Health, as well as public employee health benefits. Though not specified in the bill, it is essential to consider how a transition of responsibilities between agencies would be accomplished, and the impact of such a transition upon clients, providers and others who do business with the agency.

Before legislation is approved to transfer DSHS health care programs to HCA or any other agency, we believe the Governor’s office should demonstrate compliance with the following principles, which we urge your committee to apply in consideration of this bill:

• Name the agency and fully integrate responsibilities: Identify with certainty in the legislation the agency to which the responsibilities are transferred and ensure that its responsibilities under RCW 74.09 and other sections of RCW chapter 74 are entirely consistent and in no way conflict with its existing responsibilities.[1]
• Full disclosure: Develop a detailed blueprint describing what responsibilities will be transferred, new administrative structure, how the transition will be accomplished, a timetable to transition, technical requirements such as computer systems that are needed, and projected costs and savings due to the transition. Is the proposal still meant to be implemented in the absence of national health reform?
• Stakeholder input: Allow a meaningful opportunity for stakeholder input in response to the blueprint. In particular, consider effects of the transition on groups of clients such as those in long-term care, persons with disabilities, limited English proficient individuals, and children.
• Remove barriers, don’t add: Ensure that no additional barriers for DSHS medical program applicants, recipients, providers or others are created by the transfer of responsibilities, including during the transitional period. Rather, the purpose of this transfer is to better coordinate programs, thereby removing barriers. For example, there should be improvements in service to clients. When all programs are jointly administered, a person who no longer qualifies for one program should be able to seamlessly transition to another. The transfer should also aim to have a positive impact on provider access by increasing the number of participating providers.
• Single entry point: Keep the single application entry point for cash, medical and food, and ensure that those seeking medical benefits do not have to wait longer due to the two-agency system.
• Maintain procedures and services to clients: Maintain procedural protections for clients and providers, and continue to include in the Washington Administrative Code all rules and procedures that affect clients’ receipt of medical program benefits.
• Federal compliance: Demonstrate full compliance with federal requirements including “single state agency.” Obtain approval from DHHS before legislation is adopted.

We appreciate your consideration of this request and would be pleased to provide additional background information regarding current law and the division of responsibilities among these agencies.

Sincerely,

Northwest Health Law Advocates

AARP, WashingtonState Office

Children’s Alliance

Puget Sound Alliance for Retired Americans

SEIU Healthcare 775NW

SEIU Healthcare 1199NW

United Food and Commercial Workers, Local 21

WashingtonState Labor Council

For additional information, please contact Janet Varon of Northwest Health Law Advocates, at or (206) 325-6464

[1]For example, RCW 74.04.050 states: The department shall serve as the single state agency to administer public assistance. The department is hereby empowered and authorized to cooperate in the administration of such federal laws, consistent with the public assistance laws of this state, as may be necessary to qualify for federal funds for:
(1) Medical assistance;
(2) Aid to dependent children;
(3) Child welfare services; and
(4) Any other programs of public assistance for which provision for federal grants or funds may from time to time be made.