On May 11, Washington Governor Chris Gregoire signed six health care reform bills into law.  SB 5445 establishes a health benefits exchange development board which will create a business plan and an implementation timeline for a public-private partnership to operate Washington’s exchange in 2014 under the Affordable Care Act (ACA).   Washington is the fourth state to enact such legislation since 2010.  Governor Gregoire also signed SB 5122, which reflects ACA requirements on extending private health insurance coverage to dependents under the age of 26, eliminating life-time limits on coverage, and prohibiting pre-existing condition exclusions for persons under age 19; SB 5371, creating new enrollment procedures for persons under age 19; HB 1220, permitting public access to actuarial data submitted by health insurers on premium rate increases; HB 1311, requiring all state purchased health care programs to adopt evidence-based practice guidelines; and SB 5394, promoting the development of health homes to coordinate care for individuals with chronic conditions. 

Governor Gregoire also submitted a proposal to the U.S. Secretary of Health and Human Services, Kathleen Sebelius, on April 29, outlining the State’s “Global Medicaid Modernization Initiative”, including a wide range of value-based purchasing reforms, delivery system reforms, consumer engagement strategies, prevention/wellness initiatives, and administrative simplification initiatives.   Washington estimates that the ACA will increase its Medicaid caseload by 400,000 to 500,000 members in 2014.  Anticipating this challenge, the State is proposing to HHS a framework under which Washington would receive a federal Medicaid per capita payment with the flexibility to implement state-designed initiatives enabling it to enroll more Medicaid recipients in managed care, selectively contract with centers of excellence for specific medical procedures, enforce adherence to prescription drug lists (PDLs), encourage adherence to treatment regimens, promote medical homes and accountable care organizations (ACOs), limit coverage of services based on evidence as to clinical value, implement cost-sharing to promote more appropriate patterns of service utilization, share Medicare savings resulting from mandatory enrollment of Medicare/Medicaid beneficiaries in medical homes, and implement other creative strategies to promote efficiency, quality of care, and improved treatment outcomes.