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Health care for pregnant women

Revised Date: 
June 2, 2021

Washington apple health -- Eligibility for pregnant women

WAC 182-505-0115 Washington apple health -- Eligibility for pregnant women.

Effective August 29, 2014.

  1. A pregnant woman is eligible for the Washington apple health (WAH) for pregnant women program if she:
    1. Meets citizenship or immigration status under WAC 182-503-0535;
    2. Meets Social Security number requirements under WAC 182-503-0115;
    3. Meets Washington state residency requirements under WAC 182-503-0520 and 182-503-0525; and
    4. Has countable income at or below the limit described in:
      1. WAC 182-505-0100 to be eligible for categorically needy (CN) coverage; or
      2. WAC 182-505-0100 to be eligible for medically needy (MN) coverage. MN coverage begins when the pregnant woman meets any required spenddown liability as described in WAC 182-519-0110.
  2. A noncitizen pregnant woman who does not need to meet the requirements in subsection (1)(a) or (b) of this section to be eligible for WAH and receives either CN or MN coverage based upon her countable income as described in subsection (1)(d) of this section.
  3. The assignment of medical support rights as described in WAC 182-503-0540 do not apply to pregnant women.
  4. A woman who was eligible for and received coverage under any WAH program on the last day of pregnancy is eligible for extended medical coverage for postpartum care for a minimum of sixty days from the end of her pregnancy. This includes women who meet an MN spenddown liability with expenses incurred no later than the date the pregnancy ends. This extension continues through the end of the month in which the sixtieth day falls.
  5. All women approved for WAH pregnancy coverage at any time are eligible for family planning services for twelve months after the pregnancy ends.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Pregnancy medical (N03, N23):

This program provides CN coverage with countable income at or below 193% of the FPL without regard to citizenship or immigration status. Once enrolled in Apple Health for Pregnant Women, the individual is covered regardless of any change in income through the end of the month after the sixtieth day after the pregnancy end date (e.g., pregnancy ends June 10, health care coverage continues through August 31). Women receive this postpartum coverage regardless of how the pregnancy ends.

Women who apply for Pregnancy Medical after the baby's birth may not receive postpartum coverage, but they may qualify for help paying costs related to the baby's birth if they submit the application within three months after the month in which the child was born.

To determine the pregnant woman's family size, include the number of unborn children with the number of household members (e.g., a woman living alone and pregnant with twins is considered a three-person household).

Effective April 1, 2021

Household size Monthly income limit
1 N/A
2 $2,802
3 $3,532
4 $4,263
5 $4,993
6 $5,723

Medically needy pregnant women (P99):

This program provides MN coverage to pregnant women with income above 193% of the FPL. Individuals who qualify and enroll in Apple Health for Medically Needy Pregnant Women become eligible for MN coverage after incurring medical costs equal to the amount of the household income that is above the 193% FPL standard. For more explanation of Medically Needy benefits, please see that section of this publication.

Family planning extension (P05):

This program provides family planning services only for 10 months after Pregnancy Medical ends. Women receive the Family Planning Extension automatically, regardless of how pregnancy ends.

Family Planning Only (P06):

This program provides both men and women with incomes at or below 260% FPL coverage for prepregnancy family planning services to prevent unintended pregnancies.

Individuals access Family Planning Only services through local family planning clinics that participate in the program.

WAC 182-532-510 Family planning only program—Client eligibility

Effective November 9, 2020

To be eligible for one of the family planning only programs listed in this section, a client must meet the qualifications for that program. For the purposes of this section, "full-scope coverage" means coverage under either the categorically needy (CN) program, the broadest, most comprehensive scope of health care services covered or the alternative benefits plan (ABP), the same scope of care as CN, applicable to the apple health for adults program.

  1. Family planning only - Pregnancy related program.
    1. To be eligible for family planning only - Pregnancy related services, as defined in WAC 182-532-001, a client must be determined eligible for the Washington apple health for pregnant women program during the pregnancy, or determined eligible for a retroactive period covering the end of a pregnancy. See WAC 182-505-0115.
    2. A client is automatically eligible for the family planning only - Pregnancy related program when the client's pregnancy ends.
    3. A client may apply for the family planning only program in subsection (2) of this section up to sixty days before the expiration of the family planning only - Pregnancy related program.
  2. Family planning only program.
    1. To be eligible for family planning only services, as defined in WAC 182-532-001, a client must:
      1. Provide a valid Social Security number (SSN) or proof of application to receive an SSN, be exempt from the requirement to provide an SSN as provided in WAC 182-503-0515, or meet good cause criteria listed in WAC 182-503-0515(2);
      2. Be a Washington state resident, as described under WAC 182-503-0520;
      3. Have an income at or below two hundred sixty percent of the federal poverty level, as described under WAC 182-505-0100;
      4. Need family planning services; and
      5. Have been denied apple health coverage within the last thirty days, unless the applicant:
        1. Has made an informed choice to not apply for full-scope coverage, including family planning;
        2. Is age eighteen or younger and seeking services in confidence;
        3. Is a domestic violence victim who is seeking services in confidence; or
        4. Has an income of one hundred fifty percent to two hundred sixty percent of the federal poverty level, as described in WAC 182-505-0100.
    2. A client is not eligible for family planning only medical if the client is:
      1. Pregnant;
      2. Sterilized;
      3. Covered under another apple health program that includes family planning services; or
      4. Covered by concurrent creditable coverage, as defined in RCW 48.66.020, unless they meet criteria in (a)(v) of this subsection.
    3. A client may reapply for coverage under the family planning only program up to sixty days before the expiration of the twelve-month coverage period. The agency does not limit the number of times a client may reapply for coverage.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Effective April 1, 2021
Household size Monthly income limit
1 $2,845
2 $3,847
3 $4,850
4 $5,853
5 $6,855
6 $7,858

Find additional information about Family Planning Only.