For Immediate Release: May 16, 2022

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

State request will bring health coverage to individuals regardless of immigration status Olympia, WA

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.

“There are many in our state who have never had a chance to buy health insurance,” said CEO Pam MacEwan. “This waiver gives those individuals a chance to secure meaningful health coverage for themselves and loved ones. Additionally, this opportunity aligns with other initiatives, including Cascade Care and premium sponsorship programs, to further state efforts to strengthen the individual health insurance market and lower the rate of the uninsured.”

The Exchange conducted a state public comment period to gather feedback on the Section 1332 Waiver Application from March 31–May 2, 2022, and received overwhelming support. Comments in support of the waiver were submitted by 134 organizations representing local and national health insurance carriers; provider associations; community health clinics; consumer and immigrant advocacy organizations; state and local elected officials; and 365 individuals. All submitted public comments are available in the Washington Section 1332 Waiver Application.

Washington is requesting a Section 1332 waiver to ensure that comprehensive coverage and more affordable choices are available to uninsured Washington residents. More than 105,000 Washington state residents — nearly a quarter of the state’s total uninsured population — cannot access health insurance due to federal restrictions related to their immigration status. This adversely impacts individual health outcomes and finances, the health care sector (increasing bad debt and uncompensated care), and Washington’s economy. The waiver will enable individuals to purchase health and dental coverage through Washington Healthplanfinder and leverage state-funded affordability programs that help lower premium costs for all individual market consumers. 

Section 1332 Waivers are subject to approval by the U.S. Department of Health and Human Services and the Department of the Treasury (the Departments). For a Section 1332 waiver to be approved, the Departments must determine that the waiver meets designated federal guardrails, to ensure the coverage offered under the waiver is comprehensive, affordable, results in coverage gains, and does not increase the federal deficit.

Next steps: The Departments have up to 45 days to conduct a completeness review and then will also conduct a 30-day federal public comment period. The Exchange has requested approval by Aug. 1, 2022. After the application is deemed complete, the Departments have up to 180 days to respond to the state’s waiver request. For more information about state innovation waivers and the approval process, visit the Centers for Medicare & Medicaid Services’ website.

Enrollment is offered year-round to individuals and families through Washington Apple Health (Medicaid). Customers enrolled in Apple Health will receive a notice of 60 days before the month they enrolled in or renewed their coverage last year.

About Washington Healthplanfinder

Washington Healthplanfinder is an online marketplace for individuals and families in Washington to compare and enroll in health insurance coverage and gain access to tax credits, reduced cost sharing and public programs such as Medicaid. The next open enrollment period for Washington Healthplanfinder will begin November 1, 2022. Enrollment reports and data are available from the Washington Health Benefit Exchange

About Washington Apple Health

In Washington, Medicaid is called Washington Apple Health. Free or low-cost coverage is available year-round for those who qualify. Since the Affordable Care Act launched in October 2013, more people have access to preventive care, like cancer screenings, treatment for diabetes and high blood pressure, and many other health care services they need to stay healthy. Apple Health clients enroll and renew online using Washington Healthplanfinder. Apple Health is administered by the Washington State Health Care Authority: