State Legislation

Legislative Materials

2022 Legislative Priorities:

Below is a summary of the steps the state legislature has taken to establish the Washington Health Benefit Exchange ("Exchange") and implement Exchange-related policies:

Statutory History

  • In 2011, the legislature established the Exchange as “a public-private partnership separate and distinct from the state” governed by a bipartisan board. The Exchange is subject to public meetings and public disclosure laws. See SSB 5445.
  • In 2012, the legislature established implementation guidelines for the Exchange, including essential health benefits, market rules, and other requirements for Qualified Health Plans (QHPs). The legislature also established that the Exchange must be self-sustaining. See ESSHB 2319.
  • In 2013, the legislature established that “self-sustaining” means “capable of operating with revenue attributable to the operations of the exchange.” Revenue sources identified by the legislature include, but are not limited to, charges to health carriers, premiums paid by enrollees, and premium taxes attributable to Exchange enrollees in QHPs and stand-alone dental plans. The legislature also changed the Exchange account from a non-appropriated account to an appropriated account and included a performance audit requirement. See ESHB 1947.
  • In 2014, the legislature established additional requirements relating to the grace period, including that the Exchange submit an annual grace period report. See ESSB 6016.
  • In 2015, the legislature established additional reporting requirements for the Exchange, including:
    • Annual Strategic Plan
    • Annual 5-Year Spending Plan
    • Quarterly Reporting on Spending Metrics
    • Quarterly Financial Reports

See 2ESB 6089.

  • In 2016, the legislature established a financing mechanism so family dental products can be offered through the Exchange. See HB 2768.
  • In 2018, the legislature updated the Exchange enabling statutes to ensure that in the event of significant federal changes to the Affordable Care Act (ACA), the Exchange can continue operating as the state's eligibility and enrollment portal for the 1 in 4 residents currently using Healthplanfinder to obtain health and dental coverage. The legislature also updated outdated provisions, consolidated reporting requirements, and made other changes to align the statutes with Exchange operations.  See HB2516. The legislature also took steps to preserve statewide access to Exchange plans, requiring that starting in 2020, carriers offer them in all counties where coverage to state and school employees is offered. See HB 2408. The Exchange was also included in a bill related to automatic voter registration. See HB 2595
  • In 2019, the legislature passed Senate Bill 5526, also known as “Cascade Care.” Cascade Care created new coverage options (standard plans and public option plans) that became available through Washington Healthplanfinder during Open Enrollment on Nov. 1, 2020 for coverage effective Jan. 1, 2021 – which resulted in Washington being the first state in the country to develop and implement a public option. The Exchange was also directed to develop a plan to implement a state premium assistance program (due Nov. 2020) and analyze the impact of offering only standard plans beginning in 2025 (due Dec. 2023).
  • In 2020, the legislature established the Health Care Cost Transparency Board and included the Exchange CEO as a Board member. See HB 2457
  • In 2021, the legislature passed Senate Bill 5377, known as “Cascade Care 2.0.” This legislation made improvements to Cascade Care (standard and public option plans) and also directed the Exchange to establish a state premium assistance program for Cascade Care. In the 2021 State Operating Budget (SB 5092), funding was provided to extend premium assistance to Exchange customers earning up to 250% of the federal poverty level, beginning in 2023. Funding was also provided to: establish and implement a state premium assistance program for employees of licensed child care facilities up to 300% of the federal poverty level through 2022; provide additional outreach and enrollment support to COFA citizens; explore and implement a coverage solution for individuals without a federally recognized immigration status by 2024; and to develop and submit a report, in partnership with the HHS IT coalition, outlining next steps required for an integrated health and human services eligibility solution (due Jan 2022). The legislature also established the Universal health Care Commission (SB 5399) and included the Exchange CEO as a voting member. 
  • In 2022, the Legislature passed House Bill 1765, which permanently extends the Exchange’s Business & Occupation Tax exemption – the tax preference was previously set to expire in 2023. In the 2022 State Supplemental Budget (SB 5693), additional funding was provided to extend premium assistance to newly eligible Exchange customers under the Section 1332 Waiver who earn up to 250% of the federal poverty level, beginning in 2024. Funding was also provided to: continue the state premium assistance program for employees of licensed child care facilities up to 300% of the federal poverty level through 2023; provide additional outreach and enrollment support to promote continuous coverage when the federal Public Health Emergency expires; and support implementation of other legislative directives.

Federal Regulations

The U.S. Department of Health & Human Services continues to provide guidance and rules for the establishment and implementation
of state-based exchanges. View a full list of guidance and regulations.

American Rescue Plan Act (ARPA)

In March 2021, Congress passed the American Rescue Plan Act of 2021 (ARPA). This legislation increased and expanded eligibility for federal premium subsidies through 2022. ARPA also included provisions for those who received unemployment income  to receive subsidized coverage with $1 monthly premiums through 2021. The Washington Health Benefit Exchange was one of the first marketplaces in the country to implement the ARPA savings for its customers on May 6, 2021.

Overview of Key ARPA Provisions