H.R. 1 impacts

HCA priorities

In recent months Congress passed, and the president signed into law, federal legislation that will deeply impact Medicaid (H.R. 1). Currently, the Medicaid program (which Washington calls Apple Health) provides free or low-cost health coverage for nearly 2 million people across our state, including children, adults, pregnant individuals, those 65 years of age or older, and people with disabilities.

Our state has a sixty-year legacy of providing Medicaid to the people in Washington. As the Health Care Authority (HCA) analyzes the impacts of H.R. 1, our top priority is to implement new federal requirements in ways that minimize coverage loss and reduce customer burden.

Implementation timeline

Long description: implementation timeline summary

A timeline that shows which H.R. 1 requirements are due in the next five years, which is also detailed in the following provision table. It also includes other federal requirements:

• December 2025 - Streamlining eligibility rules: Return mail/National Change of Address
• January 2026 - CMS compliance: Medicare Savings Programs and Low Income Subsidy automation
• June 2027 - CMS compliance: non-MAGI alignment
• June 2028 - 1115 waiver: Continuous eligibility ends

Long description: implementation timeline detail in a table format

The following table lists out the federal requirements outlined in H.R. 1 and the dates they go into effect.

Provision	Effective dates
Restrictions on payment for protected health services	July 4, 2025, to July 3, 2026
Rural Health Transformation funding	Washington submitted application in November 2025; awards in December 2025; funding from 2026–2030.
Changes to coverage for lawfully present non-citizens	October 1, 2026
Work requirements for Apple Health for adults (ages 19 – 64)	January 1, 2027, with option to apply for waiver to implement December 31, 2028
Eligibility renewals increase from every 12 months to six months for Apple Health for adults (ages 19-64)	January 1, 2027
Address verification	January 1, 2027
Retroactive coverage reduced	January 1, 2027
Reduced home equity limit and removed hardship waivers for long-term care (LTC) eligibility	January 1, 2028
Provider Tax restrictions	No new provider taxes, effectively immediately. Phased in provider tax caps starting January 1, 2028.
State Directed Payment (SDP) restrictions on payments to hospitals, academic medical centers and nursing facilities	New SDPs cannot exceed Medicare levels. Grandfathered SDPs, 10% reductions begin in 2028; Continue to reduce by 10% each year until they reach Medicare levels.
Medicaid cost-sharing requirements	October 1, 2028
Good-faith waiver audit findings removed	October 1, 2029

Resources

We will post more resources to this page as HCA and our partners develop them.

About Medicaid (Apple Health) in Washington

Medicaid spending data and potential impacts of federal budget reduction proposals. These resources are updated regularly.

• Slide deck
• Fact sheet

Learn about Apple Health enrollment specialists and how clients can get help applying for health care coverage through Washington Healthplanfinder^TM.

• Enrollment specialists fact sheet

Stakeholder webinars

H.R. 1 Impacts

Join us for the first H.R. 1 Impact stakeholder webinar.

Date: February 26

Time: 12:30 - 1:30 p.m.

Register for the webinar

Presentations to the Washington State Legislature

Date	Topic	Legislative committee	Recording
December 4, 2025	Federal funding update (H.R. 1) - joint presentation with the Office of Financial Management (OFM) and the Department of Social and Health Services (DSHS)	House Appropriations Committee	Watch a recording of HCA's portion (December 4)
November 5, 2025	H.R. 1 Federal Rules briefing	Joint Select Committee on Health Care and Behavioral Health Oversight	Watch a recording (November 5)
October 16, 2025	H.R. 1 Impacts to Medicaid	Senate Ways & Means Committee	Watch a recording (October 16)
July 22, 2025	Federal Impacts to Medicaid	Senate Health & Long-Term Care Committee	Watch a recording (July 22)

Announcements