Forms & publications

Notice: If you are a biller or provider, visit our Billers and Providers forms library.

Application for Family Planning Only services for non-citizens (state-funded)

State-funded application for Family Planning Only (FPO) services for non-citizens.

13-0058
Publication

Alternate language versions:

Application for Health Care Coverage

Application for Modified Adjusted Gross Income Apple Health coverage and Qualified Health and Qualified Dental plans. (HCA 18-001P)

18-001P
Form

Order copies

Alternate language versions:

Application for Medicare Savings Program

Application for the Medicare Savings Program, which may pay your Medicare premiums, copays and deductibles.

13-691
Form

Alternate language versions:

Application for pregnant teen health care coverage (for teens under age 19)

Application for pregnant teen health care coverage for teens under the age of 19.

14-430
Form

Alternate language versions:

Application for Tailored Supports for Older Adults (TSOA) program

Application for the Tailored Supports for Older Adults (TSOA) program which provides support for caregivers who are caring for a family member for free and those who do not have a family member to help them.

18-008
Form

Order copies

Alternate language versions:

ASAM adoption readiness FAQ

Publication

Assisters for Apple Health

List of assisters available to help individuals applying for or renewing Apple Health (Medicaid) coverage in Washington Healthplanfinder.

19-000
Publication

Authorization for Release of Information

Complete this form to authorize the Health Care Authority (HCA) to release information or records to a person or organization.

80-020
Form

Authorized representatives

Webinar about authorized representatives and how the process works for Apple Health (Medicaid).

Publication

Behavioral Health Administrative Services Organization Map

Behavioral Health Administrative Services Organization Map for the current year.

19-0040
Publication

Free or low-cost health care
- I need medical, dental, or vision care
  - Find Apple Health benefits & services
  - Other Apple Health programs
  - Am I eligible?
  - Learn about my coverage
  - Use my coverage
  - Manage my coverage
- I need behavioral health support
  - Mental health
  - Substance use
  - Prenatal, children & young adults
  - American Indians & Alaska Natives
    - Behavioral health services for American Indians & Alaska Natives (AI/AN)
  - Recovery support services
  - Prevention
    - Substance use disorder prevention & mental health promotion
- I help others apply for & access Apple Health
  - Apple Health Eligibility Manual
  - Additional tools
  - Stakeholder training & education
- Quick links
- Contact Apple Health (Medicaid)
- News
Employee & retiree benefits
- Public employees
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
  - For survivors
  - Manage benefits
  - Get help
- School employees
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
  - For survivors
  - Manage benefits
  - Get help
- Retirees
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
  - Learn how & why to defer
  - For survivors
  - Manage benefits
  - Get help
- PEBB Continuation Coverage
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
    - For newly eligible members
    - Verify & enroll my dependents
  - For survivors
  - Manage benefits
  - Get help
- SEBB Continuation Coverage
  - Find benefits
  - Explore costs
  - Determine eligibility
  - Learn how to enroll
    - For newly eligible members
    - Verify & enroll my dependents
  - For survivors
  - Manage benefits
  - Get help
- Quick links
- Contact us
- PEBB news
- SEBB news
Billers, providers & partners
- Prior authorization, claims & billing
  - Getting started
  - Submit prior authorization (PA)
    - Step-by-step guide for prior authorization (PA)
    - Pharmacy prior authorization
  - Submit claims
    - Provider billing guides & fee schedules
    - Hospital rates & reimbursement
- Program information for providers
- Become an Apple Health provider
  - Learn how to enroll
  - What's next
    - Track my application
    - Find next steps for new Medicaid providers
  - For existing medicaid providers
    - Update my provider information
    - Revalidation
- Learn ProviderOne
  - Getting started
    - How do I access ProviderOne?
  - Training materials
- Quick links
- Contact us
- News
About HCA
- Programs & initiatives
- Who we are
  - About us
  - Boards, committees & collaborations
  - Health innovation
- Data & reports
- Other administrative activities
  - Medicaid-related
  - Government transparency
    - Gender identity information
    - Public disclosure request
  - Community services
    - Disaster outreach
    - Voter registration
- News
  - Find out what's new
  - Follow HCA on social media
  - For the press
    - Visit our press room
- Quick links
- Contact HCA
Contact
Login