Noncitizens

Find information about the limited coverage available to noncitizens under Apple Health (Medicaid).

Notices

Children and pregnant individuals may qualify for Washington Apple Health coverage regardless of their immigration status. View eligibility requirements for childrenpregnant individuals and After-Pregnancy Coverage to see if you qualify. If you don't qualify for Apple Health coverage, you may qualify for Family Planning Only coverage

 

Federal law requires many qualified immigrants to wait five years before becoming eligible for Medicaid. This 5-year waiting period is commonly referred to as the 5-year bar. This 5-year waiting period usually begins when the person receives their qualifying immigration status, not when they entered the U.S.

 

Programs

Medical Care Services (MCS)

MCS is state-funded health care coverage for individuals who are enrolled in one of the following programs:

  • State Family Assistance (SFA) – Survivors of Certain Crimes
  • Housing and Essential Needs (HEN) referral
  • Aged, blind, or disabled (ABD) cash program and do not meet citizenship or immigration status requirements

These programs are administered by the Department of Social and Health Services (DSHS), Community Services Division.

To be eligible, individuals must:

  • Apply for cash assistance with DSHS via:
  • Meet eligibility requirements for and enroll in, ABD cash program, HEN referral, or SFA for Survivors of Certain Crimes.

Alien Emergency Medical (AEM)

AEM is coverage for individuals who do not meet citizenship or immigration status requirements, or for qualified individuals who have not met the 5-year immigration bar and have a qualifying medical condition.

To be eligible, individuals must:

  • Meet eligibility requirements of an Apple Health program, but not be eligible for full coverage due to Citizenship and immigration requirements (which program an individual is eligible for determines whether they follow the MAGI or Classic Medicaid eligibility rules and application processing); and
  • Have a qualifying emergency medical condition, including one of the following:
    • A qualifying emergent medical condition such as emergency room care, inpatient hospital admission, or outpatient hospital surgery
    • A cancer treatment plan
    • Dialysis treatment
    • Antirejection medication for an organ transplant

State-funded long-term care

The applicant must meet all other eligibility factors for nursing home placement and receive prior authorization by the Aging & Long-Term Support Administration (ALTSA). This program is subject to caseload limits.

AEM qualifying medical conditions

More information on qualifying medical conditions and AEM coverage:

  • Inpatient, outpatient surgery and emergency room visit – Qualifying services must be provided in a hospital setting that includes evaluation and management visits by a physician and be needed to treat the emergency medical condition. Certification is limited to the dates on which the qualifying services were provided.
  • Dialysis, cancer treatment, and antirejection medication do not need to be provided in a hospital setting – The qualifying services must be needed to treat the qualifying condition of cancer, acute renal failure, or end stage renal disease, or be antirejection medication.

Applying for Apple Health coverage

The income and resource limits are designated by the program an individual is eligible for. See Apply for or renew coverage for more details.

About coverage options

Apple Health Expansion: Apple Health coverage is expanding for clients regardless of immigration status starting July 1, 2024. View the income and eligibility requirements and learn more about Apple Health Expansion.

 

Qualified Health Plans and Cascade Care Savings options for immigrants: All Washingtonians, regardless of immigration status, now have the opportunity to shop for and purchase qualified health and dental plans for 2024. Learn more about immigrant health care and other cost saving options and how to apply during a special enrollment period.