OLYMPIA – An audit of Washington’s health plan for the working poor found that the program has flaws and does not adequately indicate the quality of care patients receive.
The preliminary findings suggest the state has insufficient information to show whether its policies and practices encourage effective medical care.
The Basic Health Plan, which covers about 102,400 low-income residents who buy the insurance at reduced prices, lacked data even in areas spelled out for consideration in member handbooks, auditors said.
For example, the Health Care Authority, which manages the program, could not say whether patients were being directed to treatments for heart or diabetes conditions that are medically sound.
“It tells you, you have a program and you don’t know” what it is accomplishing, said state Rep. Fred Jarrett, R-Mercer Island. “You’re not measuring anything.”
The Health Care Authority is expected to send its comments to the Joint Legislative Review and Audit Committee for its January meeting. In the meantime, Health Care Authority deputy director Barney Speight said the agency is working to adopt some of the audit recommendations.
Dave Wasser, a spokesman for the authority, said the agency is eager to move toward more “evidence-based medicine,” one of Gov. Christine Gregoire’s priorities.
The impetus behind the audit came two years ago when GOP lawmakers discovered that a large number of people on the Basic Health Plan had incomes too high for eligibility, said Rep. Gary Alexander, R-Thurston County, the top minority member on the House Appropriations Committee.
Rules now allow participation for those earning up to 200 percent of the federal poverty line – $32,180 for a family of two and $38,700 for a family of four.
Sen. Pat Thibaudeau, D-Seattle, said she worries that the Basic Health Plan might be held to a higher standard in a health care field that is struggling to come up with performance measures.