Washington: Undocumented immigrants eligible for coverage & savings via WA HealthPlanFinder starting in 2024!

I first wrote about this back in May:

Washington state seeks federal approval to expand health insurance to previously uninsured

• State request will bring health coverage to individuals regardless of immigration status

In an effort to expand health coverage options to all residents, Washington state submitted a groundbreaking Section 1332 Waiver Application to the federal government for approval on Friday, May 13. The waiver, if approved, will allow all Washington residents regardless of immigration status to enroll in health and dental coverage through the state marketplace, Washington Healthplanfinder. If approved, the coverage will be available starting in 2024 to the newly eligible Washingtonians.

“Since the introduction of the Affordable Care Act we have been charting a course toward providing health insurance coverage for all Washingtonians,” Gov. Jay Inslee said. “This waiver comes at an important time in our health care journey and its approval would strengthen our ability to provide equitable access for historically marginalized and uninsured populations.”

In 2021, the Washington State Legislature directed the Washington Health Benefit Exchange (Exchange) to explore coverage pathways for Washington residents who do not currently qualify for state or federal coverage options. The Legislature authorized the Exchange to seek a federal Section 1332 waiver for this purpose and required a state-based solution no later than plan year 2024. If approved, the waiver will also allow newly eligible individuals and families to benefit from Cascade Care Savings, the state’s new premium assistance program, that will be starting this fall for plan year 2023.

As I noted at the time:

The most important point here is that, if approved, this would make undocumented immigrants in Washington State not only eligible to enroll in on-exchange plans via the WAHealthPlanFinder, it would also make them eligible for the new Cascade Care Savings Program, which will provide up to $55 million in supplemental state-based premium subsidies for lower-income Washingtonians (i.e., those earning up to 250% of the Federal Poverty Level). $50 million of this fund is apparently allocated for "federally-subsidized" enrollees (i.e., documented residents); another $5 million is allocated for "non-federally subsidized" enrollees (i.e., undocumented immigrants).

Well, sure enough, the 1332 waiver was just approved:

New first-in-kind federal waiver aims to improve access for uninsured Washingtonians

• Starting in 2024, all Washingtonians, regardless of immigration status, can get health and dental coverage through Washington Healthplanfinder, and access Cascade Care Savings

Today, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Treasury announced approval of Washington’s first-in-kind State Innovation Waiver under Section 1332 of the Affordable Care Act (referred to as a “section 1332 waiver”). This section 1332 waiver authorizes Washington Health Benefit Exchange (Exchange) to expand access to health and dental plans through Washington Healthplanfinder, beginning in 2024.

More than 105,000 Washington state residents — nearly a quarter of the state’s total uninsured population — cannot access health insurance through Washington Healthplanfinder due to federal restrictions related to their immigration status. Starting in 2024, all uninsured state residents – regardless of immigration status — will be able to access qualified health plans (QHPs) and stand-alone qualified dental plans (QDPs), and benefit from Cascade Care Savings (state subsidies that lower premium costs for customers up to 250% of the federal poverty level (FPL)).

“Health care should be accessible, affordable and delivered equitably to all. We are pleased to approve Washington’s Section 1332 waiver to expanded coverage and access to qualified health plans,” Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure said. “We continue to support state innovation in the ACA Marketplaces that allow residents to enroll in affordable health plan that best fits the needs of themselves and their families.”

This section 1332 waiver, which allows all family members to purchase coverage together through the same plan shopping and enrollment process, will reduce the need for individuals and families in Washington to rely on less affordable or less comprehensive forms of coverage, or on costly emergency room services and uncompensated care.

“We appreciate the federal government’s recognition of our effort to expand our successful state-based marketplace,” Gov. Jay Inslee said. “This waiver is an important step toward providing affordable health insurance coverage for all Washingtonians. Access to health care not only helps strengthen families, it also improves our overall health care system and our state economy.”

Washington’s waiver, submitted in May at the direction of the Washington Legislature, is overwhelmingly supported across multiple sectors. Hundreds of supportive public comments were received at the state and federal level by organizations representing local and national health insurance carriers; provider associations; community health clinics; consumer and immigrant advocacy organizations; elected officials; and Washington residents.

“We are thankful to our Board, the Governor’s office, Legislature, and all of the federal, state and community partners who have worked over the past year to provide access to health and dental coverage for all Washingtonians,” interim Washington Health Benefit Exchange CEO Jim Crawford said. “We now turn to the important work of building the necessary system changes to accommodate new customers and engaging with our community-based partners to inform upcoming implementation and outreach efforts.”   

This waiver approval is effective Jan. 1, 2024, through Dec. 31, 2028.

The approval letter, fact sheet and waiver application are available under “Washington” on the federal Section 1332 Waivers website. Additional waiver related materials are available on the Exchange Section 1332 Waiver Information website. 

Washington State is technically the second state to allow undocumented immigrants the ability to enroll in ACA-compliant individual market healthcare plans (including financial assistance from the state); Colorado already launched a similar program this year.

However, as Louise Norris explained to me, the difference is that Colorado set up a separate platform from their official state-based ACA exchange called OmniSalud, so undocumented immigrants don't actually use the exchange. From the enrollee's perspective it looks pretty much the same--the main web link looks identical to the Connect for Health Colorado website, but it looks like you have to contact an agent/assister/etc. directly from there using their database as a workaround.

By contrast, in Washington State's case, the 1332 waiver will allow them to enroll undocumented immigrants directly via the official state ACA exchange, Washington HealthPlanFinder.