Forms & publications

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Apple Health renewal action required for individuals turning 65

EE009

Washington Apple Health renewal action required for individuals turning 65 letter

Form

Apple Health renewal review only

EE009

Washington Apple Health renewal review only letter

Form

Apple Health restoration for COFA Islanders

19-0065

Frequently asked questions and overview of Apple Health restoration for COFA Islanders.

Publication

Apple Health termination

EE011

Washington Apple Health termination

Form

Application for aged, blind, disabled/long-term care coverage

18-005

Application for health care coverage for individuals seeking aged, blind, disabled coverage or long-term services and supports.

Form
Order Form

Application for Apple Health (Medicaid) health care coverage

18-001P

Application for Modified Adjusted Gross Income Apple Health coverage and Qualified Health and Qualified Dental plans. (HCA 18-001P)

Form
Order Form

Application for Family Planning Only services

13-781

Application for Family Planning Only services.

Form

Application for Family Planning Only services for non-citizens (state-funded)

13-0058

State-funded application for Family Planning Only (FPO) services for non-citizens.

Publication

Application for Medicare Savings Program

13-691

Application for the Medicare Savings Program, which may pay your Medicare premiums, copays and deductibles.

Form

Application for pregnant teen health care coverage (for teens under age 19)

14-430

Application for pregnant teen health care coverage for teens under the age of 19.

Form

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