OLYMPIA -- On July 22, 2007, new eligibility ceilings for Washington state's public children's health coverage go into effect, opening rolls to some 45,000 uninsured children in families with incomes up to two and half times the Federal Poverty Level.

The upshot is that children in families of four with incomes up to $51,625 will be eligible for coverage beginning July 22. Previously, some children's family incomes could be no higher than $20,650.

The 2007 Legislature approved the new standards earlier this year in a law that aims to cover all kids by 2010.

It will eventually boost the eligibility standards again, this time to three times the Federal Poverty Level. But that won’t happen until January 1, 2009. At that point, parents in families with incomes above that ceiling will be able to buy coverage for their children by paying Medicaid's full cost of coverage.

Details about the health coverage:

• The new coverage, which will be consistent with Medicaid's traditional major medical coverage, includes medical, dental and vision benefits.
• The new eligibility rule applies to all children ages 18 and under who live in Washington State and whose families meet the income criteria.
• Families with incomes more than two times the Federal Poverty Level will pay a modest monthly premium for the coverage. (The premiums are $15 per child per month, with a maximum of $45 a month per family.)
• Parents can get an application by visiting their local Department of Social and Health Services (DSHS) Community Services Office or by contacting 1-877-543-7669 (877-KIDS-NOW), a toll-free hot line that can advise them on enrollment questions.

The major effort being unleashed in July is part of Governor Chris Gregoire's initiative to cover all children in the state with health insurance by 2010. She set that goal in her early days in the office, pointing out that healthy children with access to health care will grow up as healthy adults – easing costs and chronic conditions that the health care system must deal with today.

Another fundamental change in July, made possible by the new eligibility standards, is that children will now be covered by one consolidated program.

"Kids are kids," said Doug Porter, Assistant Secretary of the Health and Recovery Services Administration, which operates the Medicaid program as well as mental health services and chemical dependency treatment. "The idea is to recognize that all uninsured kids represent a problem, no matter what their circumstances, while insured kids are a plus for everyone."

Porter said the administration also is discovering that many Medicaid family units may have some children on Medicaid while others are not. The difference is that some younger children were born in the United States and are automatically citizens – while older children may have been born abroad and must wait five years to achieve citizen status. As a result, DSHS is making every effort to track down uninsured children in its computer records for families divided like these.

DSHS will be working with the Office of Superintendent of Public Instruction and local school districts to make information available on the new program. In addition, the Basic Health program operated by the Health Care Authority will be providing information to Basic Health families about children's health programs.

Meanwhile, DSHS staff also will be checking requests for medical assistance denied over the past several months. Families that might have been ineligible before now may be eligible, and if so, DSHS will try to contact them and let them know. The department is also coordinating outreach efforts with local community-based organizations across the state to help identify uninsured children and provide application assistance.

"The prospect of getting an entire family under the same coverage and with the same primary care provider is a major step toward finding a medical home," Porter said.

"That means they will have a family doctor who is intimately familiar with an entire family's health care needs and concerns. It also means that in an era of patient-centered care, medical homes are a guarantee that the care we receive will be respectful of, and responsive to, individual patient preferences, needs and values."

Federal Poverty Level

The Federal Poverty Level is set annually by the Department of Health and Human Services. It is used as a benchmark for many anti-poverty and assistance programs:

Family % of 2007

Size FPL FPL

1 100% $10,210

4 100% $20,650

4 250% $51,625

4 300% $61,950

A number of children's health advocates are partnering with the state to help spread the word about the children's eligibility changes.

FOR ADDITIONAL INFORMATION AND BACKGROUND, CONTACT:

Andrew Krueger, Community Health Network, 206-697-1073

Jon Gould, Children's Alliance, 206-324-0340, ext. 19

Hugh Ewart, Community Health Network of Washington, 206-613-8858

Cassie Sauer, Washington State Hospital Association, 206-216-2538

Jim Stevenson, Communications Director, HRSA, DSHS, 360-902-7604 (Pager: 360-971-4067).