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 Eligibility for children.

Effective July 1, 2017.

  1. General eligibility. For purposes of this section, a child must:
    1. Be a Washington state resident under WAC 182-503-0520 and 182-503-0525;
    2. Provide a Social Security number under WAC 182-503-0515, unless exempt; and
    3. Meet program-specific requirements.
  2. Deemed eligibility groups. A child is automatically eligible for coverage without an application if the child meets the program-specific requirements in (a) through (c) of this subsection.
    1. Newborn coverage. A child under age one is eligible for categorically needy (CN) coverage if the birth parent was eligible for Washington apple health on the date of delivery:
      1. Including a retroactive eligibility determination; or
      2. By meeting a medically needy (MN) spenddown liability with expenses incurred by the date of the newborn's birth:
    2. Washington apple health for supplemental security income (SSI) recipients. A child who is eligible for SSI is automatically eligible for CN coverage under WAC 182-510-0001.
    3. Foster care coverage. A child age twenty and younger is eligible for CN coverage under WAC 182-505-0211 when the child is in foster care or receives subsidized adoption services. For children who age out of the foster care program, see WAC 182-505-0211(3).
  3. MAGI-based eligibility groups. A child age eighteen and younger is eligible for CN coverage based on modified adjusted gross income (MAGI):
    1. At no cost when the child's countable income does not exceed the standard in WAC 182-505-0100 (6)(a);
    2. With payment of a premium when the child's countable income does not exceed the standard in WAC 182-505-0100 (6)(b), and the child meets additional eligibility criteria in WAC 182-505-0215;
    3. Under chapter 182-514 WAC, if the child needs long-term care services because the child resides or is expected to reside in an institution, as defined in WAC 182-500-0050, for thirty days or longer. An institutionalized child is eligible for coverage under the medically needy program if income exceeds the CN income standard for a person in an institution (special income level);
    4. Under WAC 182-505-0117, if a child is pregnant.
  4. Non-MAGI-based children's programs. The agency determines eligibility for the:
    1. Medically needy (MN) program according to WAC 182-510-0001(6) and 182-519-0100. A child age eighteen and younger is eligible if the child:
      1. Is not eligible for MAGI-based coverage under subsection (3) of this section;
      2. Meets citizenship or immigration requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
      3. Meets any spenddown liability required under WAC 182-519-0110.
    2. SSI-related program. A child age eighteen and younger is eligible for CN or MN SSI-related coverage if the child meets:
      1. SSI-related eligibility under chapter 182-512 WAC;
      2. Citizenship or immigration requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
      3. Any MN spenddown liability under WAC 182-519-0110.
    3. SSI-related long-term care program.
      1. A child age eighteen and younger is eligible for home and community based (HCB) waiver programs under chapter 182-515 WAC if the child meets:
        1. SSI-related eligibility under chapter 182-512 WAC;
        2. Citizenship or immigration requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d); and
        3. Program-specific age and functional requirements under chapters 388-106 and 388-845 WAC.
      2. A child age eighteen and younger who resides or is expected to reside in a medical institution as defined in WAC 182-500-0050 is eligible for institutional medical under chapter 182-513 WAC if the child meets:
        1. Citizenship or immigration requirements under WAC 182-503-0535 (2)(a), (b), (c), or (d);
        2. Blindness or disability criteria under WAC 182-512-0050; and
        3. Nursing facility level of care under chapter 388-106 WAC.
  5. Alien emergency medical program. A child age twenty and younger who does not meet the eligibility requirements for a program described under subsections (2) through (4) of this section is eligible for the alien emergency medical (AEM) program if the child meets:
    1. The eligibility requirements of WAC 182-507-0110; and
    2. MN spenddown liability, if any, under WAC 182-519-0110.
  6. Other provisions.
    1. A child residing in an institution for mental disease (IMD) as defined in WAC 182-500-0050(1) is not eligible for inpatient hospital services, unless the child is unconditionally discharged from the IMD before receiving the services.
    2. A child incarcerated in a public institution as defined in WAC 182-500-0050(4) is only eligible for inpatient hospital 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 Children's Washington apple health with premiums.

Effective July 1, 2017.

  1. A child is eligible for Washington apple health with premiums if the child:
    1. Meets the requirements in WAC 182-505-0210(1);
    2. Has countable income below the standard in WAC 182-505-0100 (6)(b); and
    3. Pays the required premium under WAC 182-505-0225, unless the child is exempt under WAC 182-505-0225 (2)(c).
  2. A child is not eligible for Washington apple health with premiums if the child:
    1. Is eligible for no-cost Washington apple health;
    2. Has creditable health insurance coverage as defined in WAC 182-500-0020; or
    3. Is eligible for public employees benefits board health insurance coverage based on a family member's employment with a Washington state agency, or a Washington state university, community, or technical college.

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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