Forms & publications

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Apple Health income and resource standards - October 2016

Income standard effective 10/1/16 for the Apple Health program.

Publication

Apple Health income and resource standards - October 2017

Current income and resource standards effective 10/1/17

Form

Apple Health managed care and other private health insurance

12-378

Shares the changes to Apple Health (Medicaid) managed care in January 2017 for clients who have other primary private health insurance.

Publication

Apple Health managed care enrollment by plan and county

Report

Apple Health managed care service area map

Apple Health managed care service area map.

Publication

Apple Health managed care service area matrix

Apple Health managed care service areas matrix.

Publication

Apple Health Outreach in September 2016

Shares outreach efforts for the Washington Apple Health program including managing your coverage online, how to share your Apple Health story and more.

Publication

Application for aged, blind, disabled/long-term care coverage

18-005

Application for health care coverage for individuals seeking aged, blind, disabled coverage or long-term services and supports.

Form
Order Form

Application for health care coverage (HCA 18-001P)

18-001P

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

Form
Order Form

Application for Medicare Savings Program

13-691

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

Form

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