Forms & publications

Notice: If you are a biller or provider, visit our Billers and Providers forms library.

Administrative hearing request - DSHS Classic Medicaid

12-507

Complete this form to request an administrative hearing for DSHS Classic Medicaid.

Form

Administrative hearing request – HCA/HBE

12-511

Use 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.

Form

Administrative hearing rights and deadlines

12-506

This document provides information on your rights and the deadlines associated with administrative hearings.

Form

Administrative hearing rights and deadlines - DSHS Classic Medicaid

12-508

This document provides information on your rights and the deadlines associated with administrative hearings. For DSHS Classic Medicaid clients.

Form

Administrative hearing withdrawal

12-512

A form for withdrawing a request for an administrative hearing.

Form

Apple Health income and resource standards - April 2018

Income and resource standards effective 4/1/18

Form

Apple Health income and resource standards - January 2018

Income and resource standards effective 1/1/18

Form

Apple Health income and resource standards - January 2019

Income standards effective 1/1/19

Form

Apple Health income and resource standards - July 2018

Income and resource standards effective 7/1/18.

Form

Apple Health income and resource standards - October 2017

Current income and resource standards effective 10/1/17

Form

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