One bill in particular, Engrossed Substitute Senate Bill 5596, was sponsored by Senate Republicans led by Linda Evans Parlette of Wenatchee. It requires the state to seek a federal Medicaid waiver to give the state more flexibility and savings in its management of the state-federal health program for low-income people.
The Democratic governor signed that bill and several health care-related measures into law last week and others earlier in May. Gregoire now is headed to Washington, D.C., to push for that flexibility for all states.
And she intends to meet with federal Health and Human Services Secretary Kathleen Sebelius about her own state’s waiver request, which is already under way.
“It’s my role as head of the National Governors Association,” Gregoire said after signing SB 5596. “So on behalf of the governors, I’m going to be presenting some agreed-upon ideas where we seek flexibility from health and human services in administering the Medicaid program.”
She is expected to leave Monday, June 13.
Parlette said a federal waiver is needed to help rein in Medicaid costs. In a news release, she said the costs are running close to one-quarter of Washington’s state operating budget. She said that figure could grow as the state puts the national Democrats’ health-reforms into place and more people become eligible for Medicaid.
But Parlette, the Senate Republican Caucus chairwoman, said a waiver provides flexibility around benefits, program designs, reimbursements, cost-sharing, choices for enrollees and streamlined eligibility.
“It would also provide the state with a stable, sustainable Medicaid funding level and the opportunity for shared savings,” her release added.
An area of focus for Parlette, Democratic Sen. Karen Keiser of Kent and Gregoire is retirees dubbed “dual eligible.” These are people old enough for federal Medicare health benefits but also poor enough to receive additional help under Medicaid.
Until lawmakers approved a budget cutting it last month, the state has been helping dual-eligible clients in the Medicaid program with co-payments for prescription drugs. These are partly covered under Medicare’s Part D reform of 2003. It is one of several cuts hitting the elderly that Gregoire is expected to sign into law this month.
At the same time, Gregoire already has begun work on her waiver request from Sebelius. And she has outlined a plan to save billions in state and private-business health costs by slowing health care inflation in Washington over the next decade.
Her proposal to Sebelius cited Washington’s efforts to tame inflation in health care since 2005 – lowering it to a 2.6 percent yearly rate, less than two-thirds the 4.2 percent national rate. Gregoire also said the state may be the first and only state to cut prescription-drug costs despite increasing caseloads.
Keiser, the Kent Democrat who leads the state Senate’s Health and Long-Term Care Committee, said the goal is to have flexibility that allows the state to provide services more inexpensively. But she does not want to cut programs and opposes block grants, which U.S. House GOP members would like to enact as a way to give states flexibility while limiting federal costs for health care.
“Every state wants flexibility,” Keiser said. “States that want flexibility to do bad things should not get the flexibility. States that want to do good things should get the flexibility. We want to coordinate the care of dual eligible, the elderly and poor.”
Among the slew of other health care bills Gregoire signed into law this year: • HB 1277, which adds regulation to adult-family homes and requires them to pay more of the cost of their licensing. The reforms, fought by the industry on account of costs, grew out of a Seattle Times series of stories that revealed instances of poor care that led to criminal charges. The paper also showed that small in-home facilities, which originated as a way to help family members, had grown into full-fledged businesses marketed for sale – along with their residents – to buyers as investments.
• SSB 5445, which authorizes the state to set up a health insurance exchange in which consumers can pick, choose and buy policies. The exchange is supposed to be in place before more of the national Democrats’ 2010 health reforms take effect in January 2014, requiring exchanges. The state’s early action on the exchanges and federal reforms has won it millions in federal health care grants.
• ESSB 5122 and ESSB 5371, which align state law with the federal health-reform law. One piece extends insurance coverage to dependents younger than 26 on a parent’s plan.
CORRECTION: Gregoire's departure is on June 13. An editing error stated it as June 6.
