Program Summary - Medical Programs
Revised September 8, 2014
Purpose: This section describes the eligibility requirements for the various medical programs and coverage administered by the department.
In general, Washington Apple Health (Medicaid) programs are broken into the following types:
Apple Health MAGI Medicaid: Adult, Children's, Family and Pregnancy programs
Individuals may apply for MAGI Medicaid using the following options:
- Online: Healthplanfinder
- Paper: HCA Form 18-001 (Application for Health Care Coverage), can be submitted via:
- Mail: Washington Healthplanfinder, PO Box 946, Olympia WA 98507
- Fax: 1-855-867-4467
- Phone: 1-855-923-4633
If an individual wants help applying for MAGI Medicaid, he or she can work with a Navigator or call Healthplanfinder Customer Support at 1-855-923-4633.
Apple Health Non-MAGI (Classic) Medicaid: Longer-Term Care/Aged, Blind, Disabled programs
Individuals may apply for Classic Medicaid using the following options:
For Long-Term Care
Nursing home care, in-home personal care, assisted living facility and adult family home programs
- Online: Washington Connection
- Paper: HCA Form 18-005 (Application for LTC/ABD) , which can be submitted via:
- Mail: DSHS - Home and Community Services, PO Box 45826, Olympia WA 98504-5826
- Fax: 1-855-635-8305
- In-person: Visit a local HCS office.
- Questions? Contact a local HCS office.
For Aged, Blind, Disabled Coverage
Disability-based Washington Apple Health, Refugee coverage and coverage for seniors 65+, and programs that help pay for Medicare premiums and expenses
- Online: Washington Connection
- Paper: HCA Form 18-005 (Application for LTC/ABD), which can be submitted via:
- Mail: DSHS - Community Services Division, PO Box 11699, Tacoma WA 98411-6699
- Fax: 1-888-338-7410
- In-person: Visit a local CSO.
- Questions? Contact the Community Services Division Customer Support Contact Center at 1-877-501-2233
Income levels (such as those based on Federal Poverty Level (FPL) and Cost of Living Adjustments (COLA)) and specific program standards change yearly, but in different months. We updated the guide regularly to reflect income level and program standard changes. Please understand that, while the information in this publication is current at the time of publication, some of these standards will change before the next publication date.
We list each program's identifier after each program name on the following pages.
Health Care Authority (HCA)
The single state agency responsible for providing access to Apple Health coverage for Washington residents and state employees.
Apple Health Managed Care
Washington's prepaid comprehensive system of medical and health care services provided through a designated health care plan that contracts with Health Care Authority.
The term used to describe the non-MAGI Medicaid health care programs administered by the Department of Social and Health Services (DSHS). This includes Long-Term Care services and Aged, Blind or Disabled coverage.
Federal Poverty Level (FPL)
A guideline for determining governmental program eligibility based on the Consumer Price Index guide from the year just completed. Many health care coverage program eligibility limits are based on a percentage of the FPL.
A health care service delivery system where health care providers are paid for each service (like an office visit, test, or procedure). Individuals who are not covered by Apple Health Managed Care are covered by Medicaid fee-for-service.
The federally matched medical aid programs under Title XIX of the Social Security Act (and Title XXI of the Social Security Act for the Children's Health Insurance Plan) that cover the Categorically Needy (CN), Medically Needy (MN) and the Alternative Benefits Plan (ABP) programs.
Modified Adjusted Gross Income (MAGI)
The methodology used for calculating income and determining household composition to determine eligibility for Apple Health for Adults, Kids, Families and Caretaker Relatives, and Pregnant Women. This method follows federal income tax filing rules with a few exceptions and has no resource or asset limits.
The online payment system for health care providers serving individuals enrolled in an Apple Health program.
Scope of Care
The scope of care describes which medical and health care services are covered by the particular Apple Health program. There are 4 categories of scope of care:
- Categorically Needy (CN): The broadest, most comprehensive scope of health care services covered.
- Alternative Benefits Plan (ABP): The same scope of care as CN, applicable to the Apple Health for Adults program.
- Medically Needy (MN): The scope of care covering slightly fewer health care services than CN. MN is available to individuals who qualify for disability-based Apple Health, Apple Health for Long-Term Care, or Apple Health for Kids or Pregnant Women, except that their income and/or resources are above the applicable Apple Health program limits.3
- Medical Care Services (MCS): The scope of care covering fewer health care services than MN. MCS is a state-funded medical program available to incapacitated adults who are not eligible for Apple Health programs with CN, ABP, or MN scope of care.
Washington Apple Health
The brand name for all Washington State medical assistance programs, including Medicaid. The brand name may be shortened to "Apple Health".