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Forms & publications
Notice: If you are a biller or provider, visit our Billers and Providers forms library.
12monthsummary
Summary of coverage broken out by health plan over 12 months
Report2018 results of Parent Initiated Treatment Advisory Work Group survey
Summary of Parent Initiated Treatment survey
ReportAbout Washington Apple Health (Medicaid)
19-0031Fact sheet describing our state's Medicaid program.
Fact sheetAdding a newborn in Healthplanfinder
Step by step instructions on how to apply for a newborn under Washington Apple Health (Medicaid) in Washington Healthplanfinder.
PublicationAdministrative hearing request - DSHS Classic Medicaid
12-507Complete this form to request an administrative hearing for DSHS Classic Medicaid.
FormAdministrative hearing request – HCA/HBE
12-511Use this form to request a hearing before a judge. Mail this form within 90 calendar days of the date on eligibility notice you disagree with. You may be able to keep Apple Health coverage during the hearing process if you request a hearing in less than 10 days.
FormAdministrative hearing rights and deadlines
12-506This document provides information on your rights and the deadlines associated with administrative hearings.
FormAdministrative hearing rights and deadlines - DSHS Classic Medicaid
12-508This document provides information on your rights and the deadlines associated with administrative hearings. For DSHS Classic Medicaid clients.
FormAdministrative hearing withdrawal
12-512A form for withdrawing a request for an administrative hearing.
FormAdult dental coverage
22-811This flyer provides an overview of dental services for adults, age 21 and older, covered by Washington Apple Health (Medicaid).
Publication