Agency Overview
The Health Care Authority (HCA) administers four health care programs: Basic Health, Community Health Services, the Prescription Drug Program, and Public Employees Benefits Board (PEBB), that provide access to high-quality health care for more than 500,000 Washington residents. The HCA also oversees the Uniform Medical Plan (UMP).
Basic Health
Basic Health is a state-sponsored program that provides affordable health care coverage to low-income Washington residents through private health plans. Monthly premiums are based on family size, income, age, and the health plan selected. Copayments are required for office visits (other than preventive and maternity care), prescription drugs, and emergency room visits; other services may require a coinsurance and annual deductible. For those who qualify for Basic Health, state funds are used to help pay a portion of the monthly premium. This means members may pay as little as $17 per month for each enrolled adult. To qualify, applicants must meet Basic Health’s income guidelines, live in Washington State, not be eligible for free or purchased Medicare, and not be institutionalized at the time of enrollment.
Community Health Services
The mission of Community Health Services (CHS) is to promote access to quality and affordable health care for the uninsured, underinsured, and tribes.
To accomplish this mission, CHS will:
- Promote access by providing grants to not-for-profit community clinics to assist them in delivering primary health care (medical and dental) services to our customers.
- Assist contractors in achieving operational effectiveness and efficiency.
- Promote stability and expand the network of community clinics to foster continuity of care.
- Identify opportunities for improving relationships between the HCA and Washington Tribes.
CHS home page | CHS overview | CHS history
Prescription Drug Program
The Prescription Drug Program is a joint effort by the Uniform Medical Plan (UMP), the Department of Social & Health Services (DSHS), and the Department of Labor & Industries (L&I) and coordinated by a central office at the Health Care Authority (HCA) - the Prescription Drug Program staff.
The main goal is to develop an evidence-based prescription drug program to identify preferred drugs for use by the participating programs (UMP, L&I, and Medicaid); make prescription drugs more affordable to Washington residents and state health care programs; and, increase public awareness regarding the safe and cost-effective use of prescription drugs.
Prescription Drug Program home page
Public Employees Benefits Board (PEBB)
The state of Washington, through the PEBB program, provides medical, dental, life, and long-term disability coverage (and offers optional insurances) through private health insurance plans to eligible state and higher-education employees as a benefit of employment. Eligible retirees, former employees, and employees who are temporarily not in pay status may apply for most PEBB coverage on a self-pay basis. In addition, K-12 school districts and certain employer groups may also choose to provide PEBB coverage to their employees and retirees.
The Public Employees Benefits Board, created within the Washington State Health Care Authority, establishes eligibility requirements and approves employee premium contributions and the benefits of all participating health care organizations.
PEBB home page | Enrollment reports | K-12 school districts
Employer groups | Board Information
Uniform Medical Plan (UMP)
The Uniform Medical Plan (UMP) is administered by the HCA, and designed by the PEBB program.
UMP is a self-insured, preferred provider health insurance plan available to PEBB enrollees worldwide. In most cases, the plan allows enrollees to self-refer to any approved provider type. Care received from a network provider is covered at the highest benefit level; however, enrollees can also obtain services from most non-network providers if willing to pay more.
