SB 5967
In CommitteeSenate
Preventive health services
Preserving access to preventive services by clarifying state authority and definitions.
This status may be delayed. See Action History below for the latest updates.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill preserves access to preventive health services—including immunizations, screenings, and wellness visits—by requiring health plans to cover them without cost-sharing and by updating the state’s vaccine funding program. It clarifies Washington’s authority to rely on current federal preventive service guidelines and adds new authority for the Department of Health to issue immunization recommendations.
- Clarifies that Washington will continue to require coverage of preventive services—including immunizations, screenings, and wellness visits—without cost-sharing for nongrandfathered health plans starting April 1, 2026.
- Requires health plans to cover preventive services based on federal recommendations (e.g., U.S. Preventive Services Task Force, CDC’s Advisory Committee on Immunization Practices) and new state immunization guidance issued by the Department of Health, as of June 30, 2025.
- Empowers the Department of Health to issue evidence-based immunization recommendations and post them online, without going through formal rulemaking procedures.
- Amends the state’s universal vaccine purchase program to ensure funding for childhood vaccines by requiring health carriers and third-party administrators to pay assessments based on their enrollees’ vaccine use.
- Maintains no-cost coverage for preventive services when provided by in-network providers, and requires out-of-network coverage if no in-network provider is available.
Who is affected
- Health insurers and third-party administrators — Health insurers and third-party administrators must cover preventive services without cost-sharing and pay assessments to fund state vaccine purchases.
- Children and adolescents under age 19 — Children and adolescents under age 19 who are covered by private health plans in Washington will continue to receive preventive services like immunizations and screenings at no cost.
- Washington State Department of Health — The state Department of Health gains authority to issue immunization recommendations and guidance, influencing which vaccines and preventive services are covered.
- Washington Insurance Commissioner — The Insurance Commissioner gains rulemaking authority to ensure preventive service coverage aligns with updated federal and state recommendations.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
The bill mandates no-cost coverage for preventive services—including immunizations, screenings, and wellness visits—when provided by in-network providers, and extends coverage to out-of-network providers when no in-network option exists. This directly reduces out-of-pocket costs for Washingtonians accessing recommended preventive care, especially benefiting low- and middle-income families who are most sensitive to cost-sharing barriers.
HealthcarePeopleRef: Sec. 3(1)(d), Sec. 3(2)(b)The bill grants the Department of Health authority to issue evidence-based immunization recommendations without formal rulemaking, enabling faster adoption of new CDC guidance. This improves timeliness of coverage for emerging vaccine recommendations (e.g., new RSV or meningococcal vaccines), directly benefiting children and adolescents who rely on updated immunization schedules.
HealthcarePeopleRef: Sec. 2, Sec. 3(1)(d), Sec. 3(2)(b)The bill ensures stable, usage-based funding for Washington’s universal vaccine purchase program, which supplies vaccines to children under 19 not covered by federal programs. This strengthens childhood immunization rates, supporting herd immunity and reducing outbreak risk—particularly important in communities with low vaccination coverage or limited healthcare access.
Public SafetyPeopleRef: Sec. 5(1), Sec. 5(2), Sec. 5(4)By anchoring coverage requirements to federal guidelines (USPSTF, ACIP, HRSA) as of June 30, 2025, the bill preserves continuity of preventive care coverage during federal policy transitions. This reduces uncertainty for patients and providers and prevents gaps in coverage that could occur if Washington deferred to outdated or invalidated federal rules.
HealthcarePeopleRef: Sec. 3(1)(a)-(c), Sec. 3(2)(a)The bill prohibits cost-sharing for preventive services when provided by in-network providers, reinforcing federal ACA requirements but with state-level enforcement. While this primarily benefits enrollees in employer-sponsored and individual plans, the prohibition does not extend to out-of-network care except where no in-network provider exists—limiting universal access but still improving affordability for most.
HealthcareLean peopleRef: Sec. 3(4)(a)
Potential Concerns (5)
The bill allows health carriers to apply cost-sharing to preventive services for health savings account (HSA)-qualified plans, but only at the minimum level necessary to preserve HSA tax-exempt status. This creates administrative complexity and potential confusion for small employers and individuals managing HSAs, though the financial impact is limited due to the narrow scope and statutory limitation.
Business & EmploymentRef: Sec. 3(4)(b)The bill requires health carriers to annually review and adjust preventive service coverage based on updated federal/state guidelines and submit filings to the Insurance Commissioner. This adds routine regulatory compliance burden for insurers and third-party administrators, though the work is part of standard operations and does not significantly alter business models.
Business & EmploymentRef: Sec. 3(5)Health carriers and third-party administrators must remit assessments to fund the state’s vaccine purchase program, with costs tied to actual vaccine use by their enrollees. While this is a new cost, it is usage-based and avoids arbitrary flat fees; however, it may disproportionately impact smaller carriers with less efficient data systems to track and report vaccine use per enrollee.
Business & EmploymentRef: Sec. 5(3)The bill requires health carriers and third-party administrators to collect and report granular vaccine administration data (date, patient name, vaccine type, eligibility) for cost attribution, which increases data management and privacy compliance burdens. This is operationally routine for large insurers but may strain smaller TPA firms with limited IT infrastructure.
Business & EmploymentRef: Sec. 5(4)If assessments fall short of total nonfederal program costs, the association must cover the shortfall, and health carriers/TBAs remain obligated to pay their proportionate share. This creates a risk of cost-shifting if federal funding is reduced or enrollment shifts, potentially increasing assessments over time — though the mechanism is designed to be actuarially neutral.
Business & EmploymentRef: Sec. 5(5)
Who Is Most Affected
Children and adolescents under 19 benefit significantly: they gain continued access to no-cost immunizations and preventive screenings, supporting vaccination coverage and early disease detection. The state’s universal vaccine purchase program ensures vaccines are available regardless of family income, reducing disparities in access.
Health insurers and third-party administrators face new administrative and financial obligations—covering preventive services without cost-sharing and paying usage-based assessments to fund state vaccine purchases. While the costs are usage-based and aligned with actual service delivery, compliance with reporting and data collection requirements adds operational burden.
The Washington Department of Health gains new authority to issue immunization recommendations without formal rulemaking, increasing its influence over preventive care standards. This enhances public health responsiveness but also expands regulatory scope without corresponding budget increases, potentially straining resources.
Low-income families enrolled in Apple Health for Kids or the Basic Health Plan are *not* considered "covered lives" under the assessment scheme, meaning they do not contribute to the vaccine fund. This protects them from cost-shifting but places more of the financial burden on private insurers and TPA-administered plans, which could indirectly affect premiums.