Revised September 29, 2017
Purpose: To explain the rules and procedures on who can apply for Washington Apple Health (Medicaid) coverage, how to apply, and the minimum amount of information that must be provided to start the application process.
Medical applications of parents with joint custody of a minor dependent child
Only one household may receive health care coverage for a child, but for modified adjusted gross income (MAGI) coverage, the child may be listed on more than one application in more than one assistance unit (MAU). The household that cares for the child the majority of time receives coverage for that child, but remember that coverage follows the child within the state. When two households have joint custody of a child, the child may obtain health care services while staying at either home in Washington.
Applications by others
Individuals may apply on behalf of an individual if they have one of the following relationships to the applicant:
- A legal guardian;
- An authorized representative;
- A parent or caretaker relative of a child less than nineteen years of age;
- A tax filer applying for a tax dependent less than nineteen years of age; or
- A spouse.
Note: While others can apply for benefits on behalf of individuals, HIPAA restrictions prevent us from discussing the individual's health information with the person making the application unless the representative has power of attorney for the individual or the individual has signed an Authorization for release of information.
An authorized representative can be any adult who has sufficient knowledge of the individual's circumstances to act on the individual's behalf. In general, the individual chooses who will be their authorized representative. For more information, see Authorized Representative.
Authorized representatives are not authorized to apply on behalf of deceased individuals.
Applications while in a public institution
Prior to release from a public institution, individuals may apply for Apple Health coverage. See the Incarceration overview page for more information.
Dangerous Mentally Ill Offenders (DMIOs) - for non-MAGI Classic Apple Health programs
DSHS has a state law-required agreement with the Department of Corrections (DOC) to accept Medicaid applications from an inmate who is classified as a dangerous mentally ill offender (DMIO). The CSO that serves the area in which the correctional facility releasing the DMIO is located or an alternate CSO as designated by the Regional Office must accept applications from inmates of that facility.
(18-001) through Washington Healthplanfinder -
Program-specific application forms
Opportunity to apply
CSOs must make application forms readily available and provide a form to anyone requesting one. An individual cannot be refused to be given an application form for any reason. For MAGI-based applications done via Washington Healthplanfinder, CSOs provide computers in their lobbies for applicants to apply for health care coverage in Washington Healthplanfinder. Additionally, CSOs may offer assistance in applying in Washington Healthplanfinder when an individual is also applying for SNAP (food assistance).
Starting an application
An individual has filed a partial application when a signed application is received with at least the name and date of birth of the head of household or primary applicant and his or her physical/mailing address. Once submitted, the individual will have at least 15 days to complete the application and submit verification, if needed.
Where to apply
Applying for Apple Health through Washington Healthplanfinder is best for individuals who are:
- Adults under age 65 without Medicare;
- Adults who are parents or caretaker relatives of minor children;
- Pregnant; or
- Under age 19.
Washington Healthplanfinder applications can be completed:
- Online at www.wahealthplanfinder.org;
- By phone with the Washington Healthplanfinder Customer Support Center at 1-855-WAFINDER (1-855-923-4633);
- Through a navigator;
- By submitting a paper Health Care Coverage application (18-001P) by fax to 1-855-867-4467; or
- By submitting a paper Health Care Coverage application (18-001P) by mail to:
PO Box 946
Olympia, WA 98504
Navigators are available around the state. Navigators are a network of people, usually in clinics and hospitals, who can help individuals find and apply for coverage. The Washington Healthplanfinder Navigator Search can be found at https://www.wahealthplanfinder.org/HBEWeb/Annon_DisplayBrokerNavigatorSearch.action?brokerNavigator=NAV&request_locale=en.
Individuals not eligible via Washington Healthplanfinder but who appear to qualify for non-MAGI coverage will receive an application form by mail to apply for non-MAGI based coverage.
Non-MAGI based Classic Apple Health coverage
DSHS processes applications for individuals who are age 65 or over, eligible for Medicare, are blind or disabled, need a disability determination, or are in need of long-term services and supports. DSHS has two areas that process applications: Economic Services Administration (ESA) and the Aging and Long-Term Support Administration (ALTSA).
DSHS Community Services Office (CSO)
DSHS CSOs processes applications for individuals who are 65 or over, eligible for Medicare, are blind or disabled, or need a disability determination. Applications for non-MAGI Apple Health can be completed:
- Online at www.WashingtonConnection.org;
- By submitting a paper Application for aged, blind, disabled/long-term care coverage (18-005) by fax to 1-888-338-7410; or
- By submitting a paper Application for aged, blind, disabled/long-term care coverage (18-005) by mail to:
Community Services Division – Customer Service Center
PO Box 11699
Tacoma, WA 98411-6699
Find a local CSO at https://www.dshs.wa.gov/esa/community-services-find-an-office
ALTSA Home and Community Services (HCS)
ALTSA’s HCS processes applications for individuals not eligible for MAGI-based coverage and who are in need of care in their own home, a community residential care facility (adult family home or assisted living facility) or nursing facility. More information on the HCS application process can be found in the Medicaid and Long-Term Care Services for Adults publication (22-619).
Individuals eligible under a categorically needy (CN) or alternative benefits plan (ABP) MAGI-based program can receive long-term services and supports (LTSS) if determined functionally eligible by an ALTSA social worker or case manager. A separate application is not needed for active MAGI based individuals for Medicaid personal care (MPC), Community First Choice (CFC) or nursing facility services. If LTSS is needed, contact the HCS intake for an assessment. The intake phone numbers for a social service assessment is located under applications for LTC: https://www.hca.wa.gov/free-or-low-cost-health-care/program-administration/applications-ltc
Applications for services through HCS can be completed:
- Online at www.WashingtonConnection.org;
- By submitting a paper application for aged, blind, disabled/long-term care coverage (18-005) by fax to 1-855-635-8305; or
- By submitting a paper application for aged, blind, disabled/long-term care coverage (18-005) by mail to:
Home and Community Services – Long Term Care Services
PO Box 45826
Olympia, WA 98504-5826
Find a local HCS office at https://www.dshs.wa.gov/altsa/resources
When an individual submits an application and more information is needed to determine eligibility, they will receive a letter in the mail (unless they are receiving electronic notices through Washington Healthplanfinder). This letter will tell them what information is needed, when to submit it, and how to submit it. See the Verification chapter for more information.
Example: Jenny, age 35, has a pending application for SNAP (Basic Food) and ABD cash. At her intake interview, she requests health care coverage. She reports she is not aged or blind, but may have a disability. The CSO worker offers assistance to apply in Washington Healthplanfinder, which Jenny accepts. The worker inputs the application data into Washington Healthplanfinder and Jenny is approved for Apple Health for Adults.
Example: Maria, age 66, has a pending application for SNAP (Basic Food). At her telephone intake interview, the worker lets her know she may be eligible for non-MAGI (Classic) Apple Health. She decides to apply for coverage as well. The worker can complete an interactive interview, print the application, and mail to the individual for a signature.
Handling multiple applications from the same household (Classic Medicaid only)
- Additional applications received before we determine eligibility on the first application:
- Do not deny the additional application(s);
- Review the application(s) for impact on eligibility and whether the household is applying for any additional programs that were not selected on the first application;
- If the household is not applying for additional programs, document in the case that additional application(s) were received, the date(s) the additional application(s) were received, and that the agency is still considering eligibility under the original application date;
- If the household is applying for additional programs, treat the application as a new application for the additional programs only and continue to consider any requests for programs which are still pending under the original application date;
- Document in ACES to explain any additional information used to determine eligibility; and
- Do not extend the Timeliness period for the original application.
- Note: If the additional application is received before we determine eligibility on the first application but a worker does not act on the additional application until after the first application has been approved or denied, follow procedures under (2) below.
- Additional applications received after we determine eligibility on the first application:
- If we denied the first application, treat this as an initial application.
- Exception: If we are still within the original 30 day reconsideration period under WAC 182-503-0080 and there has not been a change of circumstances that would warrant a new request for information, then do not treat this as an initial application. Instead, treat this as a reconsideration. See Apple Health Applications - Denial and Reconsideration.
- If we approved the first application, review the additional application(s) to determine if household circumstances have changed. Take appropriate actions on any changes reported.
- If neither (a) nor (b) applies, the additional application should be denied as a duplicate application as follows:
- Use reason code 587;
- Send out the required denial letter (if not system generated); and
- Add text to explain that the application is being denied because the person(s) on the application is already receiving the Apple Health coverage.
- If we denied the first application, treat this as an initial application.
Please note: Reuse AUs! When denying additional applications as described in (b)(iii) above, avoid creating a new AU if an old AU is available.
Name, address, and signature requirements
- Name & Address
If we receive an application without a name or address to contact the individual, we make any reasonable effort we can to contact the individual to find out who the individual is and where they can be reached. If contact cannot be made, no further action needs to be taken.
- Applications Marked “Homeless”
If we receive a paper application that includes a name and signature, but is marked "homeless" and/or does not indicate a mailing address, make a reasonable attempt to locate an address or phone number for the individual. This can be done by searching the electronic case record, case narrative, ACES remarks, or past Washington Healthplanfinder applications to see if there’s a recent address reported. If no address is provided and no contact can be made, no further action needs to be taken.
- The individual/authorized representative must sign the application.
- A minor child may sign the application if there is no adult in the household.
- A mark is an acceptable signature if another person witnesses the making of the mark and signs the application.
- Online applications are considered signed electronically when transmitted.
- Telephonic signatures are accepted through Washington Healthplanfinder’s customer support center.
- See matrix below for signature requirements and date of application.
In person, mailed, emailed, faxed, dropped off, scanned, or over the phone
Yes. Always signed when submitted
May or may not be signed. Does not need to be signed in order to be accepted. Must be signed, however, to be processed
Date of Application
Date received or next business day if received after business hours
If signed, date received or next business day if received after business hours. If not signed, see "Action to Take".
Action to Take
Only applicant needs to sign in two parent households
If not signed, or taken over the phone, have the individual sign or mail back for signature. The date we receive the signature is the date of application.
Note: When an interactive interview over the phone or in-person is used to complete an application for benefits, a signature must be obtained.
Additional Situations Requiring an Application or Eligibility Review
Signed application or eligibility review forms are needed for:
- When an individual is terminated from SSI and we must re-determine eligibility under a different program.
- Adding someone new to an assistance unit who has either not previously applied, or whose previous DSHS coverage ended more than 30 days earlier.
- Medically Needy (MN) coverage, and whenever establishing a new base period. If the review is completed by phone, the AFB must be printed out and sent to the individual for signature.
- When an individual applies for a long-term care (LTC) service, such as COPES, nursing home care, or a DDA waiver, and is expected to receive the LTC service for longer than 30 days. This includes SSI recipients.
Take Charge is a program that provides women and men coverage for family planning services.
Alien Emergency Medical (AEM) applications are processed by either HCA or DSHS. See the AEM presentation for more information.
Breast and Cervical Cancer Treatment Program (BCCTP) provides health care coverage for women diagnosed with breast or cervical cancer or a related pre-cancerous condition. Find more information at the Department of Health’s BCCTP page.
The Kidney Disease Program (KDP) is a state-funded program that helps low-income, eligible individuals with treatment costs for end-stage renal disease. Eligibility is determined by each contracted kidney center. More information can be found on the KDP page.
Pregnant minors under 19 who need confidential health care coverage can apply using the Application for Pregnant Teen (14-430) form. The form can be submitted by mail or fax to:
Medical Eligibility Determination Services (MEDS)
PO Box 45531
Olympia, WA 98504-5531
Fax (360) 725-1898
Homeless teens applying on their own will need assistance with their Washington Healthplanfinder application. See the Homeless Teen Process form for more information.
Worker Responsibilities (Non-Classic Medicaid only)
Date stamping the application
- Date stamp the application, the same day we get the application, even if the application is sent to the wrong office; or
- The next business day if we received the application outside of normal business hours.
Shared Case processing / Transfers
CSO and Foster Care Medical Team (FCMT) may need to coordinate actions on shared cases involving foster and adopted children or foster alumni receiving D01, D02, or D26 medical programs. To contact the FCMT call 1-800-562-3022, extension 15480; or email at FCMT@hca.wa.gov.
CSO and MEDS staff must coordinate actions taken on shared cases. If the CSO needs a shared case transferred, email Medstransfer@hca.wa.gov. For MEDS, if there is a shared case, contact the CSO before making any change. If MEDS staff are unable to reach the CSO to take action on a shared case, they will contact the CSO supervisor of record for action.
How to Contact MEDS:
PO Box or Mail Stop 45531
Olympia, Washington 98504-5531
Phone: General Information: 800-562-3022
Email: Case transfers Medstransfer@hca.wa.gov