Cascade Care Implementation
Cascade Care aims to increase the availability of quality, affordable health coverage in the individual market.
- Addressing costs through lower premiums, lower deductibles, and providing access to services before having to pay the deductible. This includes leveraging federal and state-based financial assistance, state purchasing power, and provider reimbursement expectations.
- Encouraging more informed consumer choice with products of better value and like benefits across all participating carriers.
- Growing enrollment by attracting new enrollees and retaining current customers.
- Ensuring continued market stability through carrier participation, competitive product offerings, and a larger and more diverse risk pool.
Cascade Care News: Implementation Updates
During the 2021 legislative session, the Washington State Legislature passed Senate Bill 5377 which directed the Exchange to establish a state premium assistance program, now publicly known as Cascade Care Savings, for Washington residents. In the 2021 State Operating Budget, funding was provided to extend premium assistance to Washington residents earning up to 250% of the federal poverty level, beginning in 2023.
On April 5, 2022, the Washington Health Benefit Exchange (Exchange) released the draft Cascade Care Savings policy for public comment that has now ended. The Exchange held a public webinar to walk stakeholders through the final draft of the Cascade Care Savings policy and answer questions on April 27. The slide deck presented at the public webinar is available here. You can find a copy of the policy by clicking here and an illustrative example of calculating the state subsidy here.
In support of the eligibility changes to support Cascade Care Saving the Health Benefit Exchange (Exchange) has updated its appeals rules. You can find a draft of the Appeals Procedurals Rules here.
Final policy and materials located below under Cascade Care Savings Materials.
Cascade Care Savings will be available for plan year 2023 starting November1, 2022 during open enrollment.
Final 2023 Standard Plans
Standard Plans are offered in every county in Washington. Every carrier on the Exchange is required to offer at least one standard silver plan and one standard gold plan in every county in which they offer coverage. Carriers that offer bronze plans on the Exchange are also required to offer a standard bronze plan.
The Exchange has finalized the Standard Plan designs for plan year 2023 to be offered on Washington Healthplanfinder. You can find the final 2023 Standard Plans here.
HCA Cascade Select Procurement Released
Cascade Select is a public option individual health plan available through the Washington’s Healthplanfinder. The goal of Cascade Select is to increase the availability of quality, affordable health coverage for Washington residents who purchase individual coverage. Cascade Care is a three-agency effort involving HBE, the Health Care Authority (HCA), and the Office of the Insurance Commissioner (OIC).
The HCA released the request for proposals (RFP) for 2023 Cascade Care Select plans on February 28, 2022. Responses are due back by May 26, 2022. You can find out more information by visiting the HCA’s 2023 Procurement webpage, here.
About Cascade Care Implementation
Cascade Care created new coverage options (standard plans and public option plans) that became available through Washington Healthplanfinder during Open Enrollment on November 1, 2020 for coverage effective January 1, 2021. Cascade Care also lowers premiums for customers eligible for Cascade Care Savings, starting in 2023. Cascade Care implementation includes:
- Standard Plans: The Exchange annually develops standard plan designs by working with a wide variety of implementation partners – including agency partners, Cascade Care Workgroup members, and Exchange actuarial consultants. Standard plans, which are qualified health plans called Cascade plans that have a standard benefit design across carriers, are more understandable, more affordable, and of more value for Washington Healthplanfinder customers.
- Public Option Plans: The Health Care Authority, in consultation with the Exchange and other implementation partners, procures public option plans called Cascade Select that are available through Washington Healthplanfinder. Cascade Select plans are qualified health plans that have a standard benefit design and meet additional quality, value, and provider reimbursement and participation requirements.
- Subsidy Study: The Exchange developed and submitted a plan for implementing state premium subsidies for Washington Healthplanfinder consumers with income up to 500% Federal Poverty Level (FPL) in December of 2020. The actuarial analysis and corresponding cover memo assisted in 2021 legislative deliberations that led to the enactment of a Washington state premium assistance program, called Cascade Care Savings.
- Cascade Care Savings: The Exchange was directed to establish a state premium assistance program, and $50 million of state funds were appropriated to support the implementation of this program for plan year 2023. Cascade Care Savings will provide state premium assistance to Washington residents earning up to 250% FPL who enroll in Silver or Gold Cascade Care plans, including public option plans, through the Exchange.
This page will be regularly updated with the information about the implementation of Cascade Care. If you are interested in following this work, please subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities, and other relevant announcements. The public is also invited to attend Cascade Care Workgroup meetings to learn more about specific elements of Cascade Care implementation.
Learn more about:
What is Cascade Care?
Cascade Care legislation, Senate Bill 5526, was passed by the Washington state legislature in 2019. The bill creates new standard plans and public option plans that will be offered through Washington Healthplanfinder for Washingtonians, and directs the Exchange to develop a state premium subsidy implementation plan.
These new plan options are expected to improve the stability and affordability of the individual market and provide better value for Exchange consumers. Standard plans and public option plans will be offered exclusively through Washington Healthplanfinder during open enrollment starting November 1, 2020 for coverage beginning January 1, 2021.
What are the main components Cascade Care?
There are 3 main components:
- Standard Plans: The Exchange has developed standard plan designs. Standard plans, which are qualified health plans that have a standard benefit design across carriers, will be more understandable, more affordable, and of more value for Washington Healthplanfinder
- Public option plans: The Health Care Authority will be working to procure public option plans that will be available to Washington Healthplanfinder. Public option plans are qualified health plans that have a standard benefit design and meet additional quality and value requirements.
- Subsidy Study (premium wrap): The Exchange will be developing and submitting a plan for implementing state premium subsidies for Washington Healthplanfinder consumers with income up to 500% Federal Poverty Level (FPL). This report is due to the legislature November 15, 2020.
Standard plans will be a type of qualified health plan offered by insurance carriers on the Exchange. These plans will have a standard cost-sharing design, meaning they have the same deductible, co-pays, and co-insurance for medical services, and offer the same services before the deductible, no matter which carrier is offering it. As a result, consumers can more easily and accurately compare plans based on premium price, provider networks, customer service, and quality. Standard plans are also expected to:
- Lower deductibles
- Improve access to pre-deductible, evidenced-based services across insurers
- Provide transparent, predictable cost-sharing
Increase the value of the federal premium subsidies
What are public option plans?
Standard plans and public option plans will have the same standard benefit design across insurance carriers. Public option plans will be unique in that the provider reimbursement is tied to Medicare rates that should lower their premiums. These plans also must meet additional quality and value requirements.
When will new standard plans and public option plans be available to consumers?
Standard plans and public option plans will be offered exclusively through Washington Healthplanfinder during open enrollment starting November 1, 2020 for coverage beginning January 1, 2021.
How will the Exchange help consumers understand the new Cascade Care plan options?
The Exchange is developing tools and outreach materials for consumers that will help them select the best plan from among their available options, based on factors that are important to them - such as overall cost, provider access, and prescription drug needs. These tools and outreach materials will be informed by consumer testing and input from Exchange workgroups and committees.
How is the Washington Health Benefit Exchange, Office of Insurance Commissioner and Health Care Authority coordinating to implement Cascade Care?
Washington Health Benefit Exchange, Health Care Authority, and Office of Insurance Commissioner are working very closely together on all aspects of implementation of Cascade Care. An inter-agency workgroup meets every two weeks to coordinate work streams, which are outlined in this timeline.
How can I stay updated about and participate in Cascade Care implementation?
If you are interested in following this work, please subscribe to receive emails with information about updates to this page, upcoming meetings, stakeholder input opportunities, and other relevant announcements. The Exchange conducted a formal comment period during Fall 2019 on standard plans. Feedback from all interested stakeholders on the draft standard plan designs was solicited.
Cascade Care Workgroup
The Cascade Care Workgroup, which represents a broad spectrum of stakeholder perspectives, is working with the Exchange to implement Cascade Care. This group has regular open-public meetings during which policy and design considerations are discussed.
Plan Certification Workgroup
The Plan Certification Workgroup, which is comprised of Washington’s health and dental insurers, routinely meets to provide technical feedback to the Exchange. This group of will provide technical feedback on standard plans throughout the design process.
Exchange Board Meetings
The Exchange Board has open-public meetings every other month. High-level updates on Cascade Care implementation will be routinely provided. Standard plans designs will be presented to the Exchange Board for their review and approval in December 2019.
The Exchange is conducting a formal public comment period on the 2022 draft standard plan designs that will run from November 30, 2020 through December 29, 2020. Feedback from all interested stakeholders on the draft standard plan designs will be solicited. For more information and to submit public comment, see Cascade Care Standard Plan Public Comment.
Plan Year 2023 Materials
- Stakeholder Feedback
- Wakely - Additional Standardized Benefits Considerations
- 2023 Draft Standard Plan Options - 8.27.2021
Plan Year 2022 Materials
- 2022 Draft Standard Plan Appendix - Amended with Track Changes
- 2022 Draft Standard Plans 4.21.2021
- 2022 Draft Standard Plan AV Certification
- 2022 - Final - Standard Plans
- 2022 - Final Standard Plan AV Certification
Plan Year 2021 Materials
- Cascade Care Infographic
- 2021 QHP Guidance for Participation - Amended
- 2021 QHP Guidance for Participation - Amended with Track Changes
- 2021 Standard Plans - April
Archived 2020 Materials
- Cascade Care Approval Press Release
- Cascade Care - Design of Standard Plans Presentation
- April 2020 Wakely Standard Plan AV Certification of Unique Plan Designs
Archived 2019 Materials
- Wakely Feasibility Overview
- Wakely Report
- Wakely FAQ
- Cascade Care's Implementation Background
- WAHBE 2021 Draft Standard Plans
- 2019 Wakely Report - Standard Plan Designs - Draft 2
- 2019 Wakely Standard Plan – Draft 1 Alternatives
- 2019 Wakely Standard Plans Report
- 2019 Standard Plans Handout
- 2019 Wakely Standard Plans Report Summary
- 2019 Cascade Care's Implementation Background
- 2019 Implementation Timeline
- 2018 Wakely Report
- Summary of May 21 Meeting Feedback
- Summary of June 24 Meeting Feedback
- Summary of July 22 Meeting Feedback
- Summary of September 29 Meeting Feedback
Background Research & Data Washington State Research
- FPL and Immigration Status of the Uninsured
- Washington State’s Uninsured Rate – Washington State Health Services Research Project – OFM 2019
- American Community Survey 2018 – Percent Uninsured by FPL
National & Other State Research
- Background on Affordability
Financing & Data Analysis
- Preliminary Financing Analysis - 10/26/2020
- Funding Model Review Chart
- Health Insurance Provider Fee Background
Subsidy Model Outputs
- State Premium Assistance Policy final 5/10/2022
- State Premium Assistance Policy final with tracked changes 5/10/2022
- State Premium Assistance Policy Public Comment
- State Premium Assistance Policy Public Comment and Exchange Responses
- Appeals Procedural Rules with Tracked Changes
- Appeals Procedural Rules 05/2022
For more information on the Exchange’s Cascade Care implementation work please contact Cascade Care Workgroup at [email protected]