Apple Health (Medicaid) work requirements

How to meet work requirements

Beginning January 1, 2027, individuals eligible for Apple Health for Adults will need to meet work requirements or have an exemption to stay on Apple Health (Medicaid).

You can meet work requirements by:

• Having at least $580 monthly household income
• Working a minimum of 80 hours per month
• Enrolling in an education program at least half-time
• Participating in a work program for a minimum of 80 hours per month
• Participating in community service for a minimum of 80 hours per month
• Having a combination of work, education, work program, or volunteering that total at least 80 hours per month

If you do not meet one of these work requirement activities, you may be eligible for an exemption or current month exclusion.

Work requirement activities

There are several ways to meet work requirements, including having minimum income, participating in an education program, working, participating in a work program or community service or a combination of all activities.

Minimum monthly income

Modified Adjusted Gross Income (MAGI) is used to determine eligibility for Apple Health for Adults. To meet the minimum monthly income, monthly household MAGI income must be at least $580.

Learn more about the MAGI income threshold.

Example

Mark and Gene are married. Mark receives $200 a month in social security benefits and Gene earns $400 a month from a job. Their total household MAGI income is $600, and both adults meet the $580 per month threshold for work requirements.

Working a minimum of 80 hours per month

If you work but do not have at least $580 in monthly income, you can meet work requirements by working for a minimum of 80 hours per month. You may meet this work requirement when you work:

• In exchange for money
• In exchange for goods or services, often called in-kind work
• Unpaid

Example one

In exchange for reduced rent, Mary is the property manager for her building and works 87 hours per month. While Mary does not receive income, she meets the work requirements of working a minimum of 80 hours per month for in-kind work.

Example two

Steve is self-employed and owns a lawn care business. While his self-employment income is $200 per month, he works 150 hours per month. Steve meets the work requirements of working a minimum of 80 hours per month.

Education programs

Enrolling in an education program at least half-time meets work requirements. Education programs include:

• High school GED program at a community college
• Community college
• Vocational and technical school
• 4-year colleges and universities leading to a bachelor’s degree
• 1-2 year programs leading to a master’s or higher level degree

Half-time enrollment

Enrollment status, whether someone is full-time, half-time, or less than half-time varies depending on the institution. Check with your school to determine enrollment status.

Example one

University of Washington Tacoma considers half-time enrollment for undergraduate students as 6-11 credits and 5-9 credits for graduate.

Example two

Clover Park Technical College considers half-time enrollment as 6-8 credits.

Less than half-time education program

If your enrollment status is less than half-time based on your school’s enrollment requirements, you can use your time in school and combine it with other work requirement activities to meet a total of a minimum of 80 hours per month.

Credit hours

Credit hours	Monthly hours
1 credit hour	13 hours
2 credit hours	26 hours
3 credit hours	39 hours
4 credit hours	52 hours
5 credit hours	66 hours
6 credit hours	78 hours

Other education program hours

For schools that do not use credit hours, hours spent attending class and participating in educational activities will count.

Example

Merv is in school for welding. He attends 8 hours of instruction and trains and practices for an additional 20 hours per month. His total educational program hours are 28 per month.

Enrollment status

Enrollment status begins on the first day of the school term and continues through normal periods of attendance, vacation, and recess.

If you apply for Apple Health for Adults during a school break, your enrollment status is based on what it was just before the break.

• Learn more about four-year colleges and universities.
• Learn more about community and technical colleges.

You are considered in an education program if you graduated and are enrolled in another educational program. You are not considered in an educational program when school ended due to an expulsion or withdrawal, or you graduated and are not enrolled in another educational program.

Work program for a minimum of 80 hours per month

A work program is employment training or work-related activities designed to help you get employment or improve employability.

H.R.1 requires this Medicaid work requirement to match the Supplemental Nutrition Assistance Program (SNAP) work requirement.

Community service

Community service through unpaid work with a structured program completed for the benefit of the community meets work requirement activities. Community service hours do not have to be voluntary. They may be court ordered.

Community service cannot be partisan activities, benefit specific individuals, or be purely recreational in nature.

Examples of community service locations:

• Schools
• Humane society
• Libraries
• Food banks
• Park volunteer

Find community service opportunities near you

• Americorps - Serve Washington
• Community Emergency Response Team (CERT)
• National service, volunteerism, and civic engagement
• Washington volunteer dashboard
• Federal community service opportunities

Combination of work requirement activities

You meet work requirements when you have combination of work requirement activities that total at least 80 hours per month. This includes working, education program, work program, community service.

Example

Fred is taking a 2-credit class or the equivalent of 26 hours of work requirement activities and volunteers with the Forest Service for 60 hours per month making his total work requirement activities 86 hours per month. Fred meets the 80 hours of combination of work requirement activities.

Exclusions and exceptions

Whether applying for or renewing your Apple Health for Adults coverage, you will need to show that you recently met work requirements, an exemption, or have a current month exclusion.

Some people do not need to complete work activities to become or remain eligible for Apple Health for Adults coverage.

Current month exclusions

If you meet one of these exclusions in your application month or at renewal, you do not need to meet work requirement activities. Exclusions include:

Foster care alumni

Adults aged 18-26 who were in foster care at age 18 are eligible for Foster Care Alumni coverage and will not be enrolled in Apple Health for Adults. When they turn 27, individuals on Foster Care Alumni will be redetermined for other coverage. If you are eligible for Apple Health for Adults, you do not need to meet a work requirement because you meet a current month exclusion at renewal.

Learn more about Apple Health Foster Care.

American Indian and Alaska Native

If you are American Indian or Alaska Native (AI/AN), you do not need to meet work requirements. You will also receive a 12-month coverage period instead of a 6-month coverage period.

Learn more about the American Indians and Alaska Natives program.

Pregnant or postpartum

You do not need to meet work requirements when you are pregnant or within your 12-months postpartum period. Be sure to keep your application updated with your estimated due date or pregnancy end date.

Learn more about Apple Health for pregnant individuals and After-Pregnancy Coverage.

Parents, guardians, caretaker relatives, or family caregivers of a dependent child under age 14 or a person with a disability

Parents, guardians, caretaker relatives, and family caregivers of people with disabilities or dependent children under 14 do not need to meet work requirements.

• A dependent child is under age 14 through the month they turn 14.
• Caretaker relative is a relative by blood, adoption, or marriage who assumes primary responsibility for the child or person with disability. There are different relationships that qualify for a dependent child and a person with a disability.
• Guardian is an adult appointed by a court to care for and make personal decisions for the dependent child or person with a disability.
• Family caregiver is an adult family member or other individual that has a significant relationship with and provides care to the dependent child or person with a disability. This relationship is not limited to legally recognized relatives or members of the same household.
• Person with a disability is a person who meets the Americans with Disabilities Act definition and does not need to be classified as disabled by Medicaid or Medicare.

Veteran with a total disability rating

Veterans with a total or 100% disability rating from Veterans Affairs (VA) do not need to meet work requirements. Veterans with less than 100% disability rating do not need to meet work requirements when they receive 100% compensation.

For more information, visit U.S. Department of Veterans Affairs.

Medically frail

You do not need to meet work requirements when you are unable to work because you are medically frail. This includes people with:

• A substance use disorder (SUD)
• A disabling mental disorder
• A physical, intellectual, or developmental disability that significantly impairs their ability to perform one or more activities of daily living
• A serious or complex medical condition
• Blindness or disability (as defined in section 1614 of the Social Security Act)

View the medically frail code list to see which diagnoses and conditions apply.

In addition to this list, you are medically frail if you have:

• Nursing home services
• Medicaid Alternative Care (MAC)
• Medicaid Personal Care (MPC)
• Community First Choice (CFC)
• PACE
• Private Duty Nursing
• Preadmission Screening and Resident Review (PASRR)

You are also considered medically frail if you are a resident at Rainier School, Fircrest, Lakeland Village, or Yakima Valley School.

HCA will accept self-attestation of an individual’s medically frail status without requiring additional proof through 2027. Verification requirements of medically frail go into effect January 2028.

Beginning in 2028, HCA will try to verify an individual’s medically frail status using data sources before asking for proof. HCA will update this guidance with more detail when information becomes available.

Receiving TANF or SNAP

You do not need to meet work requirement activities when you are:

• In a Supplemental Nutrition Assistance Program (SNAP) household that meets SNAP work requirements
• Receiving Temporary Assistance for Needy Families (TANF) and meeting TANF work requirements

For more information, visit DSHS Basic Food and DSHS TANF.

Participating in a drug or alcohol rehabilitation or treatment program

You do not need to meet work requirements if you participate in a drug or alcohol rehabilitation and treatment program. The program must be a private nonprofit organization or a publicly operated community health center. It can be inpatient or outpatient.

Example

Dave enters an inpatient treatment for alcohol use disorder (AUD) treatment who helps him apply for Apple Health. He does not need to meet work requirements because he is in an AUD treatment and rehabilitation program.

Inmate of a public institution or 3 months post-release

In Washington, you may continue to be eligible for Apple Health for Adults while an inmate of a public institution. During this time, your benefits are suspended and you do not need to meet work requirements.

You also do not need to meet work requirements if you were released from a public institution such as prison within the last three months.

Example

Jenny received Apple Health for Adults while in prison. Her benefits were suspended during that time. She was released on October 3 and completed her Apple Health renewal on December 27. She does not need to meet work requirements since her release date was within the last three months.

Learn more about Medicaid suspension.

Exemptions

Having an exemption at application or renewal means you do not need to meet work requirements. Exemptions include:

Under age 19

You do not need to meet work requirements when you are under age 19.

Example

Bert is on Apple Health for Kids and is turning 19 in June. He renews his coverage in May and is eligible for Apple Health for Adults. Because he was under 19 when his coverage changed, he did not have to meet work requirements.

Enrolled in Medicare Part A or B

You do not need to meet work requirements when you are enrolled in Medicare.

Enrolled in another Apple Health (Medicaid) program

You are exempt from work requirements when you receive Apple Health through another program.

Example

Sally was enrolled in After-Pregnancy Coverage when she had to complete a renewal in February. Since she was on another Apple Health program when she completed her renewal, she is approved for Apple Health for Adults and meets this exemption because she was on another program when her coverage was renewed.

Short-term hardship exemptions

There are four short-term hardships you may meet. Two hardships you must request, while two are automatic when you apply.

Hardship	Automatic or requested
Travelling outside your community for care related to a serious or complex condition for yourself or your dependent.	Requested
Spending part of all of a month in an inpatient hospital, nursing home, ICF/IID, inpatient psychiatric hospital services, or other services of similar acuity.	Requested
Living in an area where the President has declared a disaster.	Automatic
Living in a county with an unemployment rate that is 1.5 times the national unemployment rate.	Automatic