Health care for children

Revised February 22, 2017

Apple Health for Kids

Apple Health for Kids coverage is free to children in households with income at or below 210% of the FPL and available for a monthly premium to children in households with income at or below 312% of the FPL.

WAC 182-505-0210 Washington apple health -- Eligibility for children.

Effective January 8, 2016.

  1. Unless otherwise stated in this section, a child is a person age eighteen or younger (including the month the child turns nineteen). To be eligible for one of the Washington apple health (WAH) for kids programs, a child must:
    1. Be a resident of Washington state under WAC 182-503-0520 and 182-503-0525;
    2. Provide a Social Security number (SSN) under WAC 182-503-0515 unless exempt; and
    3. Meet any additional requirements listed for the specific program.
  2. Children younger than age one are eligible for WAH categorically needy (CN) coverage, without a new application, when they are born to a mother who is eligible for WAH:
    1. On the date of the newborn's birth, including a retroactive eligibility determination; or
    2. Based on meeting a medically needy (MN) spenddown liability with expenses incurred by the date of the newborn's birth.
  3. Children are eligible for WAH at no cost when they:
    1. Have countable family income that is no more than two hundred ten percent of the federal poverty level (FPL) under WAC 182-505-0100;
    2. Are currently eligible for supplemental security income (SSI); or
    3. Received SSI payments in August 1996 and would continue to be eligible for those payments except for the August 1996 passage of amendments to federal disability definitions.
  4. Children are eligible for premium-based WAH under WAC 182-505-0215 when they:
    1. Have countable family income that is not more than three hundred twelve percent of FPL under WAC 182-505-0100;
    2. Do not have other creditable health insurance under WAC 182-500-0020; and
    3. Pay the required monthly premiums under WAC 182-505-0225.
  5. Children are eligible for WAH home and community based waiver programs under chapter 182-515 WAC when they:
    1. Meet citizenship or immigration status under WAC 182-503-0535;
    2. Meet SSI-related eligibility requirements under chapter 182-512 WAC; and
    3. Meet program-specific age requirements.
  6. Children are eligible for the WAH long-term care program when they meet the institutional program rules under chapter 182-513 or 182-514 WAC, and either:
    1. Reside or are expected to reside in a medical institution, intermediate care facility for the intellectually disabled (ICF/ID), hospice care center, or nursing home for thirty days or longer; or
    2. Reside or are expected to reside in an institution for mental diseases (IMD) (as defined in WAC 182-500-0050(1)) or inpatient psychiatric facility:
      1. For ninety days or longer and are age seventeen or younger; or
      2. For thirty days or longer and are age eighteen through twenty-one.
  7. Children are eligible for the WAH-MN program under WAC 182-519-0100 when they:
    1. Meet citizenship or immigrant status under WAC 182-503-0535;
    2. Have countable family income that exceeds three hundred twelve percent of FPL under WAC 182-505-0100; or
    3. Have countable family income that is more than two hundred ten percent of FPL, but are not eligible for premium-based WAH as described in subsection (4) of this section because of creditable coverage; and
    4. Meet a spenddown liability under WAC 182-519-0110, if required.
  8. Children are eligible for WAH SSI-related programs under chapter 182-512 WAC when they:
    1. Meet citizenship or immigration status under WAC 182-503-0535;
    2. Meet SSI-related eligibility under chapter 182-512 WAC; and
    3. Meet an MN spenddown liability under WAC 182-519-0110, if required.
  9. Children who are not eligible for WAH under subsections (5) through (8) of this section because of their immigration status, are eligible for the WAH alien emergency medical program if they:
    1. Meet the eligibility requirements of WAC 182-507-0110;
    2. Have countable family income:
      1. That exceeds three hundred twelve percent of FPL under WAC 182-505-0100; or
      2. That is more than two hundred ten percent of FPL, but they are not eligible for premium-based WAH, as described in subsection (4) of this section because of creditable coverage; and
    3. Meet a spenddown liability under WAC 182-519-0110, if required.
  10. Children who are in foster care or receive subsidized adoption services are eligible for coverage under the WAH foster care program described in WAC 182-505-0211.
  11. Children who are incarcerated in a public institution (as defined in WAC 182-500-0050(4)) that is not an IMD, are not eligible for any WAH program unless they are receiving inpatient hospital services outside of the public institution.
  12. Children who reside in a public institution that is an IMD are eligible for WAH under this section but are not eligible to receive inpatient hospital services outside of the IMD unless they are unconditionally discharged from the IMD before receiving the services.

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.

April 1, 2017

Household Size Monthly Income Limit
210% FPL
(No Cost)
Monthly Income Limit
260% FPL
($20 Premium Child, $40 Maximum)
Monthly Income Limit
312% FPL
($30 Premium/Child, $60 Maximum)
1 $2,111 $2,613 $3,136
2 $2,842 $3,519 $4,222
3 $3,574 $4,424 $5,309
4 $4,305 $5,330 $6,396
5 $5,037 $6,236 $7,483
6 $5,768 $7,141 $8,570

Apple Health for Newborns (N10):

This program provides 12 months of CN coverage if the mother was enrolled in an Apple Health program when the child was born. There is no resource or income limit for this program.

Apple Health for Kids (N11, N31):

This program provides CN coverage to children under age 19 whose families have income at or below 210% of the FPL. Children who would have been eligible for Apple Health for Kids except for not meeting the immigration status requirements receive CN coverage under state-funded Apple Health for Kids.

Apple Health for Kids with Premiums (N13, N33):

This program provides CN coverage to children under age 19 whose families have income above 210% and at or below 312% of the FPL in exchange for the monthly premium. Children who would have been eligible for Apple Health for Kids with premiums except for not meeting the immigration status requirements receive CN coverage under state-funded Apple Health for Kids with Premiums in exchange for the monthly premium.

WAC 182-505-0215 Washington apple health -- Premium-based children's program -- Purpose and scope.

Effective August 29, 2014.

The medicaid agency administers the programs included in Washington apple health (WAH) for kids that provide premium-based coverage through a combination of state and federal funding sources as described below:

  1. Federally matched health care coverage as authorized by Title XXI of the Social Security Act state children's health insurance program (CHIP) and RCW 74.09.450 for citizen and federally qualified immigrant children whose family income is above two hundred ten percent of the federal poverty level (FPL) but is not above three hundred twelve percent FPL.
  2. State funded health care coverage for children with family income above two hundred ten percent FPL, but not above three hundred twelve percent FPL, who are ineligible for federally matched health care coverage due to immigration status.

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.

Apple Health for Medically Needy Kids (F99):

This program provides MN coverage to children under age 19 whose families have income above 312% of the FPL. Children who qualify and are enrolled in Apple Health for Medically Needy Kids become eligible for MN coverage after incurring medical costs equal to the amount of the household income that is above the 312% FPL standard. For an explanation of Medically Needy benefits, please see that section of this publication.

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