Fiscal Watch – May 15, 2024

Please join WSHA and state Health Care Authority (HCA) staff on Thursday, June 20^th from 12:00 PM-1:00PM to learn about a new state health care coverage program available to undocumented residents, called Apple Health Expansion (AHE). Registration in advance is required, please click here to register.

In this webinar, WSHA and HCA staff will discuss how coverage options available to undocumented Washingtonians obtained through the Alien Emergency Medical Programs, After-Pregnancy Coverage,  Apple Health for Kids differ from the new AHE program. We will highlight how processes are similar to current Apple Health coverage and how workflows may need to change with the introduction of AHE. Lastly, we will include information about how this program interacts with hospital obligations under the state Charity Care law. 

On July 1, 2024, HCA estimates around 13,000 eligible individuals will be able to enroll in the Apple Health Expansion program. This new program comes from legislatively authorized state-only funding approved during the 2023 Legislative session. AHE provides “Medicaid-like” health coverage for adults aged 19 or older earning less than 138% of the federal poverty level, regardless of immigration status. The benefits will be managed by 4 of the 5 managed care organizations (MCOs) and the enrollment is capped and tied to funding. 

For all content related questions, please reach out to Mary Storace (marys@wsha.org). If you have any questions about webinar registration, please reach out to Kyandra Espindola (kyandrae@wsha.org) for assistance. 
(Mary Storace, marys@wsha.org)

24 state Attorneys General, including the Attorney General for Washington State, sent United Healthcare a letter advising that it should not favor its own entities in its response to the widespread disruptions as a result of hacker activity on Change Healthcare.

Since Change Healthcare acts as the primary clearinghouse for claims submissions and electronic transmissions for many providers between a variety of payors, the impact on claims submission, payment and communications is broader.  While Change Healthcare reportedly has regained most of its functions, many payors are not yet willing to reconnect through Change Healthcare. This leaves hospitals, providers, and pharmacies few or no workarounds for claims submission and payment, as well as critical transmissions such as prior authorization requests.

WSHA has been actively communicating the magnitude of the issue to state agencies. Recently the Office of the Insurance Commissioner sent a memorandum to carriers that they should consider the disruption to be an extenuating circumstance for purposes of prior authorization and they should provide flexibility in timely claims filing for impacted providers.  It also advised carriers they should not restrict the ability of providers to change clearinghouses from Change Healthcare. More information and a link to resources is here.
(Caitlin Safford, caitlins@wsha.org)

With conclusion of the 2024 legislative session, WSHA Government Affairs staff will provide member bulletins and implementation resources for laws passed during session. Members are encouraged to periodically check our New Law Implementation Guide page for new bulletins and resources.  The page and the schedule below will be updated regularly, as new resources are released. WSHA’s Bulletin Schedule for 2024 can be found here. To access WSHA’s comprehensive list of bulletins, please visit this page. (Mary Storace, marys@wsha.org)