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### Review of State Health Care Coverage Eligibility: Findings and Recommendations ###

This report by the Joint Legislative Audit and Review Committee (JLARC) evaluates the eligibility requirements and processes for 73 health care coverage programs in Washington State. The study focuses on employee benefits, social services, and expansion programs, providing detailed program summaries that include eligibility and exclusion criteria, income limits, and the eligibility determination process. Recommendations for the Department of Social and Health Services (DSHS) emphasize updating administrative rules and ensuring public-facing information is consistent and current, enhancing understanding and access for potential recipients. ###

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### Review of State Health Care Coverage Eligibility: Findings and Recommendations ###

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  1. State Health Care Coverage Eligibility Study Proposed Final Report Joint Legislative Audit & Review Committee October 22, 2008 Fara Daun, JLARC Staff

  2. Study Mandate and Scope • 2007-09 Biennial Operating Budget directs JLARC to: “conduct a review of the eligibility requirements and eligibility review processes that apply to any state program that offers individual health care coverage for qualified recipients.” • This study evaluates those health care coverage programs for which the state both: • Determines a person’s eligibility for the program; and • Participates in funding the program. Charge to JLARC Report page 3 State Health Care Coverage Eligibility Proposed Final Report

  3. The State Has 73 Health Care Coverage Programs in 3 Categories • Employee Benefit Programs (13) • Social Service Programs (54) • Expansion Programs (6) WHAT JLARC FOUND State Health Care Coverage Eligibility Proposed Final Report Report pages 1, 4-5

  4. New Tool for Comparing Health Care Coverage Programs • Report’s primary focus is an inventory of the State’s 73 health care coverage programs • Each program has a Program Summary page • Brief description • Eligibility criteria • Exclusionary criteria • Identifies criteria as federal, state, or negotiated • Summary of the eligibility determination process • Income limits table (if applicable) • Comments PROGRAM SUMMARIES State Health Care Coverage Eligibility Proposed Final Report Report pages 1, 19-22

  5. Recommendation • DSHS should update its administrative rules that relate to the scope of coverage, income limits and eligibility to ensure that they reflect current criteria and are understandable to the general public. DSHS should also ensure that its administrative manuals are consistent with each other and the administrative rules and that its publicly available information is up to date. • DSHS made some changes during this study including updating WAC and manual sections, and developing a scope of coverage chart. RECOMMENDATION State Health Care Coverage Eligibility Proposed Final Report Report page 18

  6. Agency Responses DSHS and OFM concur in the recommendation. Although there were no recommendations for HCA, HCA’s formal response raises the issue that recent court orders limit their ability to administer eligibility. RECOMMENDATION State Health Care Coverage Eligibility Proposed Final Report 6 Report page 18

  7. Contact Information Fara Daun 360-786-5174 daun.f@leg.wa.gov www.jlarc.leg.wa.gov State Health Care Coverage Eligibility Proposed Final Report

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