Apple Health phone lines down Thursday, April 18
The Apple Health customer service phone lines will be down Thursday, April 18, from 11:30 a.m. to 2:30 p.m. We apologize for the inconvenience. View other ways to contact Apple Health.
The Apple Health customer service phone lines will be down Thursday, April 18, from 11:30 a.m. to 2:30 p.m. We apologize for the inconvenience. View other ways to contact Apple Health.
This section describes the eligibility requirements for the various medical programs and coverage administered by the department.
Effective June 11, 2023
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.
In general, Washington Apple Health (Medicaid) programs are broken into the following types:
Individuals may apply for MAGI Medicaid using the following options:
If an individual wants help applying for MAGI Medicaid, they can work with a Navigator or call Healthplanfinder Customer Support at 1-855-923-4633.
Individuals may apply for Classic Medicaid using the following options:
Nursing home care, in-home personal care, assisted living facility and adult family home programs
Disability-based Washington Apple Health, Refugee coverage and coverage for seniors 65+, and programs that help pay for Medicare premiums and expenses
Income levels (such as those based on federal poverty level (FPL) and cost of living adjustments (COLA)) and specific program standards change yearly, but in different months. We updated the guide regularly to reflect income level and program standard changes. Please understand that, while the information in this publication is current at the time of publication, some of these standards will change before the next publication date.
The single state agency responsible for providing access to Apple Health coverage for Washington residents and state employees.
Washington's prepaid comprehensive system of medical and health care services is provided through a designated health care plan that contracts with Health Care Authority.
The term used to describe the non-MAGI Medicaid health care programs administered by the Department of Social and Health Services (DSHS). This includes Long-Term Care services and Aged, Blind or Disabled coverage.
A guideline for determining governmental program eligibility based on the consumer price index guide from the year just completed. Many health care coverage program eligibility limits are based on a percentage of the FPL.
A health care service delivery system where health care providers are paid for each service (like an office visit, test, or procedure). Individuals who are not covered by Apple Health managed care are covered by Medicaid FFS.
The federally matched medical aid programs under Title XIX of the Social Security Act (and Title XXI of the Social Security Act for the Children's Health Insurance Plan) that cover the Categorically Needy (CN), Medically Needy (MN) and the Alternative Benefits Plan (ABP) programs.
The methodology used for calculating income and determining household composition to determine eligibility for Apple Health for Adults, Kids, Families and Caretaker Relatives, and Pregnant Women. This method follows federal income tax filing rules with a few exceptions and has no resource or asset limits.
The online payment system for health care providers serving individuals enrolled in an Apple Health program.
The scope of care describes which medical and health care services are covered by the particular Apple Health program. There are four categories of scope of care:
The brand name for all Washington State medical assistance programs, including Medicaid. The brand name may be shortened to "Apple Health".