Issues in Developing Programs for Uninsured Children: A Resource Book for States. Washington Basic Health Plus



In 1993, Washington State created the Basic Health Plus program for children under 200% of the federal poverty level through a Medicaid expansion. These children were previously eligible for health insurance through the full state-subsidized Basic Health Plan established in 1988, under which adults below 200% of the federal poverty level still receive coverage. The Basic Health Plus program was established to take advantage of the federal funding available through Medicaid. Children covered under the program receive a comprehensive benefit package at no cost to their family. Provider networks are aligned between the Basic Health Plus program and the Basic Health Plan so that families can visit the same physicians.


Children ages 0-19 whose families earn less than 200% of the poverty level are the target population of Basic Health Plus.


The Washington Basic Health Plus program has the same rich benefit package traditionally provided under the state Medicaid program. This includes all preventive services, plus benefits such as inpatient care, dental care, eyeglasses and hearing aids. Basic Health Plus provides routine screenings of up to $125 per child per calendar year without co-payment (this does not apply to well-baby care). Immunizations and well-child visit are covered up to a maximum of $400 per calendar year for children ages 1-4. Children receive a 50% discount on glasses and a 25% discount on contact lenses. There is an unlimited inpatient stay, but care must be authorized within 48 hours of admission.


There are currently fourteen managed care plans contracting with Basic Health Plus. There is almost a complete overlap between the provider network utilized by Basic Health Plus and that used by the Basic Health Plan.


The program is funded through a combination of state and federal funds through the Medicaid match. State funds are obtained primarily through state taxes on cigarettes and alcohol.