History

Forty Years of Caring:

In the 60s there was an emergence of grassroots activists and organizations working for the needs of Americans living in low-income areas.  The work of these groups moved the U.S. Congress and dozens of state governments to formulate and implement domestic health policy through funds from President Johnson’s “War on Poverty” and the U.S. Public Health Service.  One result was the enactment of federal funding to establish local, community based health clinics.

This grassroots movement had an impact on Washington State and community clinics began to open to help the underserved access primary care.  In 2008, there are 25 federally funded community health centers (CHCs) in Washington State; 23 are members of WACMHC.  In addition to the federally funded CHCs belonging to WACMHC is an Urban Indian Health Program.*

Throughout the years, Washington State has responded to the increases in the uninsured and the needs of the underserved.  There is a state-funded grant program for community clinics, a program to provide health insurance to the working poor, and a commitment by the state to ensure that all children have insurance coverage and access to care by 2010.

Community Health Services Grants

The Community Health Services (CHS) program is one of Washington State’s primary commitments to ensuring access to primary care for uninsured people.  The CHS grant program allocates state dollars to non-profit community health clinics that meet a specific set of requirements, including providing medical and dental care regardless of an individual’s ability to pay through a sliding fee schedule.

  • 1985:  Legislature authorizes a small grant program to community clinics to fund medical services for uninsured people and awards $948,500 in grant funds to 26 community clinic contractors for 1986.
  • 1987:  CHS program expands to include dental services.
  • 1991:  CHS program expands to include funding for migrant services.
  • 2002:  Funding increases to expand dental services for non-citizen immigrant populations.
  • 2005:  CHS program cut by $5M, or 22%. Community health centers (CHCs) face decreased access for the uninsured, increased wait times, reduced staffing levels, and decreasing programs.
  • 2006: CHCs advocate for the restoration of the CHS grants – and succeed in restoring $4M to the program for the next biennium.  In 2007, the CHCs are awarded over $9M in CHS grant funding (84% of the total grant awards).
  • 2007: CHCs advocate for an additional $24M in dental funds, but do not receive them.  The program continues to be funded at 2006 funding levels.

Basic Health

The Basic Health program provides affordable, no-frills health insurance to low-income people who share the costs with the state and who would otherwise not have access to coverage. Basic Health currently covers approximately 106,500 Washingtonians with incomes at or below 200% of the Federal Poverty Level, and they pay a portion of the monthly premium on a sliding scale basis dependent on family income.

  • 1987:  Legislature enacts the Basic Health program.  It was created to provide a subsidized, low cost insurance program for the state’s growing uninsured population.  At the time it consisted of 20,000 slots on a prepaid, managed care model offered through many managed care plans.
  • 2001:  Initiative 773 (I-773) is approved by voters, raising the cigarette tax to fund an expansion to the Basic Health program from 130,000 slots to 175,000 slots.
  • 2003:  Legislature cuts 30,000 Basic Health slots and re-directs I-773 funds; the program is capped at 100,000 slots.
  • 2006:  6,500 Basic Health slots are restored to the program to bring the program to a total of 106,500 enrollees.
  • 2007: An additional $9M was provided to increase Basic Health by 3,000 slots phased in over the biennium. However, the anticipated movement of children from Basic Health to DSHS coverage is expected to reduce the number of available Basic Health slots.

Children’s Health

Washington State has shown a strong commitment to children’s health in the past decade, but there have been many changes to children’s health programs.

  • 1991:  Children’s Health Program (CHP) launches.  The program primarily covers Medicaid-ineligble children up to age 18, including immigrant children, in families up to 100% of the federal poverty level (FPL).  Though state-only dollars. CHP provides fee-for-service coverage similar to Medicaid, including preventative care, vision and dental care.
  • 1999:  Legislature establishes a Children’s Health Insurance Program (CHIP) for children up to age 19 in households with incomes between 200 and 250% of the FPL.  Approximately 10,000 children are estimated to be eligible for the program.
  • 2002:  CHP is eliminated and enrollees are instead offered the option of enrolling in Basic Health.  CHS grants to community clinics are also increased to cover the cost of uncompensated dental care.
  • 2003 – 2005:  Number of immigrant children on Basic Health steadily declines.
  • 2005:  Legislature passes HB 1441 with a promise to Cover All Children by 2010 and reinstates the CHP for an estimated 4,300 children.
  • 2006:  Legislature increases the budget for the CHP to cover an additional 10,000 children, significantly reducing the waiting list for the program.
  • 2007: Legislature passes historical legislation (SB 5093) to cover all kids by 2010.

*The Seattle Indian Health Board is also an Urban Indian Health Program, but receives CHC funding from the Bureau of Primary Health Care in addition to its Title V status.