43.71A.010  <<  43.71A.020 >>   43.71A.800

EligibilityCosts to be paidDisqualificationEstablishment of proceduresOutreach.

(1) An individual is eligible for the COFA premium assistance program if the individual:
(a) Is a resident;
(b) Is a COFA citizen;
(c) Enrolls in a silver qualified health plan;
(d) Has income that is less than one hundred thirty-three percent of the federal poverty level; and
(e) Is ineligible for a federal or state medical assistance program administered by the authority under chapter 74.09 RCW.
(2) Subject to the availability of amounts appropriated for this specific purpose, the authority shall pay the premium cost for a qualified health plan and the out-of-pocket costs for the coverage provided by the plan for an individual who is eligible for the premium assistance program under subsection (1) of this section.
(3) The authority may disqualify a participant from the program if the participant:
(a) No longer meets the eligibility criteria in subsection (1) of this section;
(b) Fails, without good cause, to comply with procedural or documentation requirements established by the authority in accordance with subsection (4) of this section;
(c) Fails, without good cause, to notify the authority of a change of address in a timely manner;
(d) Withdraws the participant's application or requests termination of coverage; or
(e) Performs an act, practice, or omission that constitutes fraud, and, as a result, an insurer rescinds the participant's policy for the qualified health plan.
(4) The authority shall establish:
(a) Application, enrollment, and renewal processes for the COFA premium assistance program;
(b) The qualified health plans that are eligible for reimbursement under the program;
(c) Procedural requirements for continued participation in the program, including participant documentation requirements that are necessary for the authority to administer the program;
(d) Open enrollment periods and special enrollment periods consistent with the enrollment periods for the health insurance [health benefit] exchange; and
(e) A comprehensive community education and outreach campaign, working with stakeholder and community organizations, to facilitate applications for, and enrollment in, the program. Subject to the availability of amounts appropriated for this specific purpose, the education and outreach program shall provide culturally and linguistically accessible information to facilitate participation in the program, including but not limited to enrollment procedures, benefit utilization, and patient responsibilities.
(5) The community education and outreach campaign conducted by the authority must begin no later than September 1, 2018.
(6) The first open enrollment period for the COFA premium assistance program must begin no later than November 1, 2018.
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