Washington:

Coverage to All Children

 

Background

Before the inception of the State Children's Health Insurance Program (SCHIP) in 1997, Washington covered children in families with incomes up to 200 percent of the federal poverty level (FPL) through Medicaid. In addition, the state provided coverage to children, regardless of immigration status, in families with incomes up to 200 percent of the FPL through a separate state-funded program. Washington developed a separate SCHIP program in 1999 to cover children in families with incomes between 200 percent and 250 percent of the FPL. Along with the coverage expansion, Washington adopted a number of policies to simplify the enrollment and application processes and invested in outreach to find and enroll eligible children. According to Washington State Population Survey data, by 2002 only 4.5 percent of all children in Washington were uninsured.

Washington's forward movement changed in 2002 when state policymakers began to face significant budget deficits. To obtain savings, state policymakers pushed a number of policy changes for Medicaid and SCHIP, including a shift from 12 months continuous eligibility to a 6 month renewal period, the elimination of self-declaration of income, and the elimination of the program for immigrant children not eligible for Medicaid or SCHIP.* According to data from the state Medicaid agency, the combined effect of these policy changes resulted in more than 50,000 children losing coverage between late 2002 and 2005.

A coalition of child advocates convened by the Children's Alliance, called the Health Coalition for Children and Youth (HCCY), worked against the policy changes and documented, on a monthly basis, what they meant for families. Members of the coalition include the Washington State Hospital Association, American Academy of Pediatrics, Community Health Network of Washington (representing many of the community health clinics), and the state's children's hospitals. In late 2004, the Children's Alliance, working with HCCY, issued a report Condition Critical: Washington's Curable Children's Health Crisis that quantitatively and qualitatively (through interviews with families) documented the impact of the policy changes on children's coverage.



*Note: when the program for immigrant children ended, funding to serve these children was transferred to the state's Basic Health Program (BHP). BHP is a state-funded program that was designed for and largely serves adults and has significant cost-sharing requirements. The transition to BHP was not automatic for these children and most children either did not transfer to the program or did not stay enrolled in BHP.