Health care for pregnant individuals

Revised date
Purpose statement

Washington apple health -- Eligibility for pregnant individuals

WAC 182-505-0115 Washington apple health -- Eligibility for pregnancy and after-pregnancy coverage.

WAC 182-505-0115 Washington apple health -- Eligibility for pregnancy and after-pregnancy coverage.

Effective June 24, 2022.

  1. A pregnant person is eligible for Washington apple health pregnancy coverage if the person:
    1. Meets citizenship or immigration status under WAC 182-503-0535;
    2. Meets Social Security number requirements under WAC 182-503-0115;
    3. Meets Washington state residency requirements under WAC 182-503-0520 and 182-503-0525; and
    4. Has countable income at or below the limit described in:
      1. WAC 182-505-0100 to be eligible for categorically needy (CN) coverage; or
      2. WAC 182-505-0100 to be eligible for medically needy (MN) coverage. MN coverage begins when the pregnant person meets any required spenddown liability as described in WAC 182-519-0110.
  2. A noncitizen pregnant person who does not meet the requirements in subsection (1)(a) or (b) of this section is eligible for apple health pregnancy coverage if they meet countable income standards for CN or MN coverage as described in subsection (1)(d) of this section.
  3. The assignment of medical support rights as described in WAC 182-503-0540 does not apply to pregnant people.
  4. A person who was eligible for and covered under any CN or MN scope of coverage apple health program on the last day of pregnancy remains continuously eligible for after-pregnancy coverage for 12 months, beginning the month after their pregnancy ends. This includes people who meet an MN spenddown liability with expenses incurred no later than the date the pregnancy ends.
  5. Pregnancy coverage has CN scope of care for all people except those enrolled through the MN program who have MN scope of care. A person's after-pregnancy coverage has the same scope of coverage as their pregnancy coverage.
  6.   A person who does not meet the requirements in subsection (4) of this section may qualify for after-pregnancy coverage if they:
    1. Apply for and meet all requirements of the apple health pregnancy coverage program other than pregnancy; and
    2. Apply any time during their 12-month postpartum period to receive ongoing medical coverage until the end of the 12th month after their pregnancy ends. 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Pregnancy medical (N03, N23):

This program provides Categorically Needy (CN) coverage with countable income at or below 193% of the FPL without regard to citizenship or immigration status. Once enrolled in Apple Health for Pregnancy, the individual has continuous coverage regardless of any change in income through the end of the month after the pregnancy ends (e.g., pregnancy ends June 10, Apple Health for Pregnancy coverage continues through June 30th). 

To determine the individual's family size, include the number of unborn children with the number of household members (e.g., an individual living alone and pregnant with twins is considered a three-person household).

Effective August 2022

Household size Monthly income limit
1 NA
2 $2,945
3 $3,704
4 $4,464
5 $5,223
6 $5,982

Medically needy pregnant women (P99):

This program provides Medically Needy (MN) coverage to pregnant individuals with income above 193% of the FPL. Individuals who qualify for and enroll in Apple Health for Medically Needy Pregnant Women become eligible for MN coverage after incurring medical costs equal to the amount of the household income that is above the 193% FPL standard. For more explanation of MN benefits, see that section of this publication.

After-Pregnancy Coverage  (N04/N24/N07/N27):

After- Pregnancy Coverage (APC) provides CN coverage to individuals any time in the 12 months after their pregnancy ends.

APC begins regardless of how the pregnancy ends. Individuals on an Apple Health program while pregnant will automatically receive 12 months of postpartum coverage. APC begins the month after the pregnancy ends and is continuous coverage regardless of a change in income or household composition.

Individuals who were not on an Apple Health program during the time of their pregnancy may apply for APC and receive postpartum coverage, as long as it is within twelve months after the month in which the pregnancy ends.

Family Planning Only (P06):

This program provides services for those with incomes at or below 260% FPL coverage for pre-pregnancy family planning services to prevent unintended pregnancies.

Individuals access Family Planning Only services through local family planning clinics that participate in the program.

WAC 182-532-510 Family Planning only program - Client eligibility

WAC 182-532-510 Family planning only program—Client eligibility

Effective November 9, 2020

To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program. For the purposes of this section, "full-scope coverage" means coverage under either the categorically needy (CN) program, the broadest, most comprehensive scope of health care services covered or the alternative benefits plan (ABP), the same scope of care as CN, applicable to the apple health for adults program.

  1. Family planning only - Pregnancy related program.
    1. To be eligible for family planning only - Pregnancy related services, as defined in WAC 182-532-001, a client must be determined eligible for the Washington apple health for pregnant women program during the pregnancy, or determined eligible for a retroactive period covering the end of a pregnancy. See WAC 182-505-0115.
    2. A client is automatically eligible for the family planning only - Pregnancy related program when the client's pregnancy ends.
    3. A client may apply for the family planning only program in subsection (2) of this section up to sixty days before the expiration of the family planning only - Pregnancy related program.
  2. Family planning only program.
    1. To be eligible for family planning only services, as defined in WAC 182-532-001, a client must:
      1. Provide a valid Social Security number (SSN) or proof of application to receive an SSN, be exempt from the requirement to provide an SSN as provided in WAC 182-503-0515, or meet good cause criteria listed in WAC 182-503-0515(2);
      2. Be a Washington state resident, as described under WAC 182-503-0520;
      3. Have an income at or below two hundred sixty percent of the federal poverty level, as described under WAC 182-505-0100;
      4. Need family planning services; and
      5. Have been denied apple health coverage within the last thirty days, unless the applicant:
        1. Has made an informed choice to not apply for full-scope coverage, including family planning;
        2. Is age eighteen or younger and seeking services in confidence;
        3. Is a domestic violence victim who is seeking services in confidence; or
        4. Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.
    2. A client is not eligible for family planning only medical if the client is:
      1. Pregnant;
      2. Sterilized;
      3. Covered under another apple health program that includes family planning services; or
      4. Covered by concurrent creditable coverage, as defined in RCW 48.66.020, unless they meet criteria in (a)(v) of this subsection.
    3. A client may reapply for coverage under the family planning only program up to sixty days before the expiration of the twelve-month coverage period. The agency does not limit the number of times a client may reapply for coverage.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Effective July 2021
Household size Monthly income limit
1 $2,945
2 $3,968
3 $4,990
4 $6,013
5 $7,036
6 $8,058

Find additional information about Family Planning Only.