Waiver would expand health care coverage to Washingtonians regardless of immigration status


Shane Ersland


Washington State officials are seeking the federal government’s approval for a waiver that would expand health care coverage to residents regardless of their immigration status.


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The Washington Benefit Exchange (Exchange) submitted a Section 1332 waiver to the federal government on May 13th. If approved, the waiver will provide access to federally non-subsidized health and dental coverage through Washington Healthplanfinder to all residents regardless of immigration status starting in 2024. 

“The state of Washington has been a leader in exploring innovative ways to increase access, improve quality, and reduce the number of Washington residents who lack coverage,” Gov. Jay Inslee wrote in a letter supporting the waiver. “This waiver furthers recent efforts to expand coverage, including implementation of Cascade Care. By decreasing the number of uninsured, addressing health disparities, strengthening the individual market, and improving health care affordability, this waiver also takes an important step forward in addressing health equity.”

The waiver would also allow newly eligible customers up to 250% FPL to access Cascade Care Savings, the state’s new premium assistance program that will be accessible in 2023.

The state’s legislature directed the Exchange to explore coverage pathways for residents who did not qualify for state or federal coverage in 2021. Approximately 105,000 residents cannot access health insurance due to federal restrictions related to their immigration status.

The Exchange conducted a public comment period to gather feedback on the waiver application from March 31 through May 2. The waiver received an abundance of support with 410 comments from 134 organizations representing health plans, providers, consumer advocates, state and local officials, and 365 individuals.

“In Washington today, many immigrants go without critical health care because they are structurally excluded from affordable health coverage,” Washington Association for Community Health CEO Bob Marsalli wrote in comments included in the application. “Over 100,000 of Washington’s immigrant residents lack insurance today due to this systemic inequity. Left with no recourse, many of these community members currently forego needed care until it becomes an emergency. As you know, without insurance, people are more likely to have poor health status, be hospitalized for preventable conditions and acute illnesses, and die prematurely.”

The U.S. Department of Health and Human Services and the Department of the Treasury will review the waiver’s application for completeness. The departments will have up to 45 days to conduct a review. They will then conduct a 30-day federal public comment period. The Exchange has requested approval by Aug. 1. After the application is deemed complete, the departments will have up to 180 days to respond to the state’s request.