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Washington has taken a significant step toward expanding health and dental insurance coverage to nearly all residents, particularly those who are undocumented.

The Washington Health Benefit Exchange, the state’s health insurance marketplace, on Friday submitted a waiver application that, if approved, allows states to bypass or change some Affordable Care Act requirements. If the federal government greenlights the waiver in the coming months, thousands more Washingtonians will be eligible for new health and dental benefits starting in 2024, the exchange said in a statement this week.

“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 in the statement. “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.”

If the waiver is approved, the state could become one of the first in the country to offer comprehensive benefits regardless of immigration status.

About 2 million Washingtonians currently receive health care through the exchange, said Michael Marchand, the marketplace’s chief marketing officer. Under the ACA, undocumented immigrants (with an exception for those who are pregnant and children) are not eligible to buy health coverage through wahealthplanfinder.org, an online tool administered and operated by the exchange.

The waiver would expand access to more than 105,000 people — about 23% of the state’s total uninsured population — according to the application.

“We hear far too many stories of people who put off care because they don’t have insurance until it becomes a huge health and financial burden for them,” Marchand said. “And then they wind up using the emergency room as their primary care physician, which, in the end, is actually more expensive to all of us.”

The federal government has approved waivers from several other U.S. states, including Oregon, Colorado, Alaska, Montana, Georgia, Pennsylvania and Maine, though none of the applications were related to immigration status, according to a 2020 report from the Kaiser Family Foundation.

In 2016, California applied to expand access to health coverage for undocumented immigrants, but state lawmakers withdrew the application the following year because they feared the Trump administration would use information from the plan to deport residents, Kaiser Health News reported.

Plans to submit the waiver had been in place since last year, when the state Legislature directed the exchange to explore different coverage options for those who don’t qualify for state or federal health insurance. In the past, the Centers for Medicare & Medicaid Services has also encouraged states to take advantage of section 1332’s “flexibility.”

In Washington’s application, the state asks to waive a particular section of the ACA that bars undocumented immigrants from purchasing health insurance through the Healthplanfinder.

The application is now in the hands of the U.S. Department of Health and Human Services and the Department of the Treasury, which will consider whether or not coverage offered under the waiver is “comprehensive, affordable, results in coverage gains and doesn’t increase the federal deficit,” the statement said.

The waiver would also leverage state-funded affordability programs that help lower premium costs for customers, in addition to increasing access to Cascade Care Savings, the state’s new premium assistance program scheduled to open this fall.

“There are many in our state who have never had a chance to buy health insurance,” exchange CEO Pam MacEwan said in the statement. “This waiver gives those individuals a chance to secure meaningful health coverage for themselves and loved ones.”

The federal government has up to 45 days to review the application, before holding a month-long public comment period. It then has up to 180 days to respond to the request, though the state asked for approval by the beginning of August.

“As time has progressed, we’ve seen more and more requests to focus on specific populations to drive down the overall uninsured number in Washington state,” Marchand said.

Although the state has been busy the last two years ensuring people who lost their jobs during the pandemic don’t slip through coverage gaps, Marchand said it was exciting to submit the waiver application and possibly open doors to a “population who, in the past, has been overlooked.”

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