Washington aims to provide health coverage for foster care youths from other states through Medicaid waiver amendment


Shane Ersland


Washington health officials have applied for a Medicaid waiver amendment that would provide health coverage for former foster care youth from other states.


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The Washington State Health Care Authority (HCA) hosted a webinar to discuss how the amendment would help youths on Thursday. Amy Dobbins, Apple Health (the state’s Medicaid program) eligibility policy section manager for the Office of Medicaid Eligibility Policy, said a state must apply for a Section 1115 Medicaid demonstration waiver when it wants to make changes from normal Medicaid guidelines.

Washington received its Medicaid Transformation Project (MTP) waiver in 2017. The waiver ends on June 30th, and HCA submitted a renewal application for it in July 2022. 

“Last year, we applied to CMS to renew it for another five years,” Dobbins said.

HCA Medicaid Director Charissa Fotinos, MD, said the MTP waiver renewal was a primary focus for the agency during the Washington State of Reform Health Policy Conference in January.

“We’ll have a lot of conversations with CMS this year about moving that forward, and getting to an agreement on the things we’d like to do, and what they agree to help support us with doing,” Fotinos said.

The HCA and the Department of Social and Health Services have requested an amendment to the current waiver. If approved, the waiver would authorize Medicaid coverage for former foster care (FFCC) youth from other states who turned 18 prior to Jan. 1st. Coverage would remain intact until enrollees reach age 26. It would also provide continuous enrollment for Children’s Health Insurance Program (CHIP) coverage for CHIP children during the first six years of their lives. 

“Coverage under the waiver would apply through Dec. 31st, 2030,” Dobbins said. “We anticipate 180 FFCC enrollees would be eligible for coverage during the MTP period.”

The HCA has also submitted a State Plan Amendment (SPA) to cover foster youth from other states who turn 18 after Jan. 1st.

“Between both authorities (the amendment and SPA) our state can cover all foster care youth from out of state, regardless of when they turn 18,” Dobbins said.

If approved, the amendment would allow CHIP children in families with incomes up to 317% of the federal poverty level to be continuously enrolled until the end of the month in which their sixth birthday falls. HCA estimates that 16,707 enrollees would be continuously enrolled from 2024 to 2028.

Nearly 2.3 million Washingtonians were eligible for Apple Health in December 2022, and 99,921 were American Indian/Alaska Native. Gaps in coverage are higher for children of color age six and under, as data shows 4.6 to 6.3 months of disruption in coverage over 600 months of possible coverage, Dobbins said.

“With this amendment, we think we can reduce disruption of coverage,” she said. “If approved, the amendment will help our state continue coverage and ensure coverage of children at risk of losing coverage. Both of these (initiatives) are really aligned with our goals to advance and improve health outcomes in Washington.”

The deadline to submit public comments for the amendment is May 22nd at 5 p.m. Those who wish to provide comments can do so here or by mail: Washington State Health Care Authority, Policy Division, Attention: Tamarra Henshaw, P.O. Box 45502, Olympia, WA 98504-5502.