Apple Health managed care changes
Health Care Authority implemented changes to the Apple Health managed care program. You may learn more about these changes below.
Changes in January 2017
If you have Apple Health (Medicaid) and other primary health insurance
If you or someone in your household has Apple Health (Medicaid) coverage in addition to primary private health insurance (such as Group Health or Blue Shield), changes are coming to how the Washington State Health Care Authority (HCA) provides your Apple Health coverage.
Beginning January 1, 2017, the agency will enroll most fee-for-service Apple Health clients who have other primary health insurance into an agency-contracted managed care organization (MCO). Learn what you need to do.
Changes in April 2016
Newly eligible Medicaid clients and renewing clients choose or are auto-assigned into a managed care organization (MCO) the day they become eligible. Their managed care enrollment will be backdated to the beginning of the current month. The intent of the change is to close the fee-for-service (FFS) gap between eligibility and enrollment. This change decreases the time on FFS with quicker care coordination. Instead of having to wait another month or possibly two months before being enrolled, the client now enters the plan on the first day of the month that they became eligible.
Clark and Skamania Counties, also known as SW WA region, create the first region in Washington State to initiate Fully Integrated Managed Care (FIMC). This means that physical health, mental health, and drug and alcohol treatment are coordinated through one managed care plan.
Clients may choose from Community Health Plan of Washington (CHPW) or Molina Healthcare of Washington (MHW) in the SW WA region.
Behavioral Health – Administrative Service Organization (BH-ASO) or mental health crisis services and short-term substance use disorder (SUD) crisis services are provided by Beacon Health Options of Washington in SW WA.
Behavioral Health Services Only (BHSO) in the SW WA region are available to clients who are Medicaid eligible but not eligible for managed care. They will have a choice of CHPW or MHW for these behavioral health services. These clients include:
- Dual eligible – Medicare/Medicaid
- Foster care
- American Indian/Alaska Native (AI/AN)
- Medically needy
- Clients who have met their spenddown
- Non-citizen pregnant women
- Individuals in Institutions Mental Disease (IMD)
- Long-term care residents
- Clients with other carrier coverage
The Department of Social and Health Services (DSHS) manages the contracts for mental health and substance use disorder (SUD) services for 9 of the Regional Service Areas (RSA) in the state, excluding the Southwest Washington (SW WA) Region. The BHOs replace the Regional Support Networks (RSN). BHOs are integrating mental health and SUD services (known as behavioral health services), transforming two service delivery systems into one region wide system. View a listing of BHOs in Washington.
Coordinated Care of Washington (CCW) provides physical health care (medical) benefits, lower-intensity outpatient mental health benefits and care coordination for all Washington State foster care enrollees through a single, statewide managed care plan called Apple Health Core Connections. Inpatient services and higher-level outpatient mental health services will be provided by the BHSO in the SW WA region or the BHO in BHO regions.
These clients include children and youth:
- Under the age of 21 who are in foster care
- Under the age of 21 who are receiving adoption support
- Age 18 to 26 years old who aged out of foster care on or after their 18th birthday
AHCC clients are auto-enrolled to CCW with the ability to opt out with a phone call to the foster care unit. American Indian/Alaska Native (AI/AN) children are not auto-enrolled.
Find support available to you, based on where you live:
24-hour crisis line
In Clark and Skamania counties only
For more information about changes to Apple Health managed care, please see the following resources: