Health care for adults

Revised date
Purpose statement

To understand the programs associated with health care for adults.

Adult medical (N05)

This program provides CN coverage to adults with countable income at or below 133% of the FPL who are between the ages of 19 up to 65, who are not incarcerated, and who are not entitled to Medicare.

WAC 182-505-0250 Washington apple health -- MAGI-based adult medical.

WAC 182-505-0250 Washington apple health -- MAGI-based adult medical.

Effective August 29, 2014.

  1. Effective on or after January 1, 2014, a person is eligible for Washington apple health (WAH) modified adjusted gross income (MAGI)-based adult coverage when he or she meets the following requirements:
    1. Is age nineteen or older and under the age of sixty-five;
    2. Is not entitled to, or enrolled in, medicare benefits under Part A or B of Title XVIII of the Social Security Act;
    3. Is not otherwise eligible for and enrolled in mandatory coverage under one of the following programs:
      1. WAH SSI-related categorically needy (CN);
      2. WAH foster care program; or
      3. WAH adoption support program;
    4. Meets citizenship and immigration status requirements described in WAC 182-503-0535;
    5. Meets general eligibility requirements described in WAC 182-503-0505; and
    6. Has net countable income that is at or below one hundred thirty-three percent of the federal poverty level for a household of the applicable size.
  2. Parents or caretaker relatives of an eligible dependent child as described in WAC 182-503-0565 are first considered for WAH for families as described in WAC 182-505-0240. A person whose countable income exceeds the standard to qualify for family coverage is considered for coverage under this section.
  3. Persons who are eligible under this section are eligible for WAH alternative benefit plan as defined in WAC 182-500-0010 coverage. A person described in this section is not eligible for medically needy WAH.
  4. Other coverage options for adults not eligible under this section are described in WAC 182-508-0001.

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 $1,428
2 $1,931
3 $2,434
4 $2,938
5 $3,441
6 $3,944

Family medical (N01)

This program provides CN coverage to adults with countable income at or below the applicable Medicaid standard and who have dependent children living in their home who are under the age of 18.

WAC 182-505-0240 Parents and caretaker relatives.

WAC 182-505-0240 Parents and caretaker relatives.

Effective July 1, 2017.

  1. A person is eligible for Washington apple health categorically needy (CN) coverage when the person:
    1. Is a parent or caretaker relative of a dependent child who meets the criteria described in WAC 182-503-0565(2);
    2. Meets citizenship and immigration status requirements described in WAC 182-503-0535;
    3. Meets general eligibility requirements described in WAC 182-503-0505; and
    4. Has countable income below the standard in WAC 182-505-0100 (2).
  2. To be eligible for coverage as a caretaker relative, a person must be related to a dependent child who meets the criteria described in WAC 182-503-0565(2).
  3. A person must cooperate with the state of Washington in the identification, use and collection of medical support from responsible third parties as described in WAC 182-503-0540.
  4. A person who does not cooperate with the requirements in subsection (3) of this section is not eligible 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, 2019

Household size Monthly income limit
1 $511
2 $658
3 $820
4 $972
5 $1,127
6 $1,284

Health care extension (HCE) (N02)

This program provides CN coverage to individuals who lost eligibility for Family Medical because of an increase in their earned income after they received Family Medical coverage for at least 3 of the last 6 months. These individuals are eligible for up to 12 months extended CN medical benefits (Medical Extension).

WAC 182-523-0100 Washington apple health--Medical extension

WAC 182-523-0100 Washington apple health--Medical extension.

Effective December 28, 2019

  1. A parent or caretaker relative who was eligible for and who received coverage under Washington apple health for parents and caretaker relatives, described in WAC 182-505-0240, in any three of the last six months is eligible, along with all dependent children living in the household, for twelve months' extended health care coverage if the person becomes ineligible for coverage due to increased earnings or hours of employment.
  2. A person remains eligible for apple health medical extension unless:
    1. The person:
      1. Moves out of state;
      2. Dies; or
      3. Leaves the household.
    2. The family:
      1. Moves out of state;
      2. Loses contact with the agency or its designee or the whereabouts of the family are unknown; or
      3. No longer includes an eligible dependent child as defined in WAC 182-503-0565(2).
  3. When a person or family is determined ineligible for apple health coverage under subsection (2)(a)(i) through (iii) or (b)(i) or (ii) of this section during the medical extension period, the agency or its designee redetermines eligibility for the remaining household members as described in WAC 182-504-0125 and sends written notice as described in chapter 182-518 WAC before apple health medical extension is terminated.

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.

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