Tribal affairs

The Office of Tribal Affairs' (OTA) role within the Health Care Authority is to support, strengthen, and honor our state’s government-to-government relationship and unique partnership with Tribes. OTA works to ensure Washington state recognizes and protects the interests, rights, and sovereignty of Tribal Nations for the provision of health care for their Tribal members.

OTA guides HCA work alongside Tribes and other partners to support the health and well-being of American Indian and Alaska Native people. Some of this work includes:

  • Health care coverage options
  • Mental health and substance use disorder prevention, treatment, and recovery support
  • Crisis services
  • Transitional care planning
  • Peer counseling

In addition, we partner, convene, facilitate, create policies and programs, train, support, and oversee agency efforts related to Tribes, Urban Indian Health Programs, Indian health care providers, and Tribal-serving organizations.

How do I?

American Society of Addiction Medicine (ASAM)

The ASAM Criteria defines the treatment criteria and levels of care for the treatment of substance-related and co-occurring conditions. The ASAM Criteria structure is the underlying framework for our service codes (billing guides), fiscal assumptions (rates), etc.

Under state law, licensed behavioral health agencies (BHA) providers are required to use The ASAM Criteria. Managed care organizations (MCOs), behavioral health administrative services organizations (BH-ASOs) contracted by the Health Care Authority (HCA), and private insurance plans use The ASAM Criteria as a utilization management tool.

The ASAM Criteria, 4th Edition, Volume 1, Adults is now available.

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Want to stay up to date on the ASAM?

Sign up to receive ASAM updates.

4th edition timeline

SB 5361 passed in the 2025 legislative session, delaying the adoption date until January of 2028.

Read the ASAM adoption readiness FAQ

While the adoption date is delayed, clinicians are encouraged to continue to work on quality improvement.

Information about ASAM trainings

HCA in partnership with Train for Change offered comprehensive free trainings for providers between July 2024 and June 2025. While the state does not anticipate receiving funding for additional training, we appreciate everyone who took the time to participate in past trainings.

As of 2026, the state will communicate any instance of refresher courses and/or resources. There will be ASAM Technical Assistance support pre and post implementation. Please look for quarterly communication updates.

The Adolescent and Transition Age Youth version is anticipated to be released in 2026.

Vision

The Public Employees Benefits Board (PEBB) Program provides a variety of vision plans for PEBB employers, except medical-only employer groups.

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Plan availability

Standalone vision plans offered by the PEBB Program are available to all benefits eligible employees whose employer offers the full benefits package.

Effective January 1, 2025, routine vision coverage is separate from medical coverage.

Before selecting a plan or provider, employees should compare vision plans to find out what services are covered, which providers are in-network, and the costs for care.

What do the vision plans cover?

  • Each plan will have a network of providers that offers services like routine eye exams, eyeglass frames and lenses, contact lenses, and discounts on treatments like LASIK.
  • All plans will offer private practice optometrists and ophthalmologists in Washington State and nationwide, but each plan’s network will include different providers. These plans were chosen to cover as many counties in Washington as possible, but not all plans will have network providers in all areas.
  • In addition to private practice locations, each plan will offer a selection of retail locations, such as Costco Optical, Walmart, Sam’s Club, America’s Best, Visionworks, LensCrafters, Pearle Vision, and Target Optical.

PEBB Program vision plans

Cost for vision coverage

The cost for vision coverage is included in the total rate, paid by the employer for eligible employees of state agencies and higher education institutions. PEBB Participating employer groups determine what portion of the rates eligible employees pay. Find your organization's PEBB Program rates.

Davis Vision by MetLife

Davis Vision is underwritten by the Metropolitan Life Insurance Company (MetLife).

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

Davis Vision preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the Davis Vision provider directory.

Contact information

Phone: 1-877-377-9353 (TTY: 1-800-523-2847)
Online: Davis Vision

EyeMed

EyeMed Vision Care is underwritten by Fidelity Security Life Insurance Company (FSL).

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

EyeMed Vision Care preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the EyeMed Vision Care provider directory.

Contact information

Phone: 1-800-699-0993 (TTY: 1-800-699-0993)
Online: EyeMed Vision Care

MetLife Vision

Plan documents

Preauthorization criteria

Preauthorization is when a covered individual seeks approval from their health plan for coverage of specific services, supplies, or drugs before receiving them. Some services or treatments (except emergencies) may require preauthorization before the plan pays for them. Preauthorization is not a guarantee, however, that the plan will pay for those services, supplies, or drugs.

MetLife Vision preauthorization criteria

These criteria do not imply or guarantee approval. Please check with the plan to ensure coverage. Preauthorization requirements are only valid for the month published. They may have changed from previous months and may change in future months.

Find a provider

Visit the MetLife Vision provider directory.

Contact information

Phone: 1-855-638-3931 (TTY: 1-800-428-4833)
Online: MetLife Vision

Member ID cards

Once a member is enrolled in vision, no matter what the carrier/plan, members are sent a welcome packet that includes two copies of an ID card with the subscribers name.

Welcome packets also include instructions on how to set up an online account, where members can download and print additional copies of cards, access forms, and check eligibility and benefits.

Members do not need to present an ID card in order to receive services. In-network providers have access to secure portals to look up eligibility and benefit information based on the subscribers name.

Apple Health Expansion

Revised date
Purpose statement

Apple Health Expansion (AHE) is a state funded, capped enrollment (limited enrollment due to funding) program for individuals who do not meet the citizenship or immigration status requirements of other Apple Health programs.

Who may be eligible?

  • Washington residents aged 19 or older,
  • Have countable income at or below 138% of the federal poverty level (FPL),
  • Do not qualify for other Apple Health programs based on immigration status,
  • Are not pregnant or did not have a pregnancy end in the last 12 months, and
  • Are not eligible for qualified health plans with advance premium tax credits (APTC), federally funded medical assistance programs.
  • Are not eligible for another Apple Health program

What is the financial eligibility for AHE?

There are no resource limits for the AHE program. Clients will need to have income at or below 138% of the FPL. For the current 2024 FPL income standards by household, visit the Apple Health Expansion program webpage.

How to apply

Individuals who are 65 or older apply through the Department of Social and Health Services (DSHS)

Individuals who are under the age of 65 apply through Washington Healthplanfinder (HPF)

For more information, visit the Apple Health Expansion program webpage.

Both the Health Care Authority (HCA) and DSHS will process AHE applications. Clients aged 19-64 will be automatically processed in HPF (and all other acceptable application pathways) giving either an approval or denial based on the attested information of the client. For individuals aged 65+ DSHS will process their application coming through Washington Connection and all other acceptable application pathways and give either an approval or denial based on the confirmed information of the client.

What if the cap is on?

If the CAP is on, with EPICS approval, HCA and DSHS may manually process and approve applications for AHE.

HCA – MAGI Apple Health Expansion (AHE) worker responsibilities

HCA processes AHE applications under MAGI when:

  • Individual is age 19 through 64.
  • Individual is not eligible for Medicare, or any other federally funded Apple Health programs, and follows MAGI rules established through the Healthplanfinder.
  • If AHE has open availability individuals will be approved if they meet all eligibility requirements for the program.

Processing the application manually due to CAP being on

  1. Review the individual's income and immigration status to ensure they are not eligible for any other federally funded MAGI programs.
  2. Is the client eligible for Apple Health Expansion based on attested information:
    1. If yes, continue with manual application processing
    2. If no, sends denial letter (If one has not already auto generated from HPF Dashboard) for AHE.
      1. Did client mark AEM? If yes client will be reviewed for AEM eligibility
  3. If client is determined eligible for AHE staff manually approves client and sends approval letter.

"Submit information" letter

If attested income does not verify, verify important deadline to submit information letter generates.

Immigration status

If attested immigration status does not match information on file (i.e. attests to no immigration status but there is information on file, or attested immigration status does not verify), follow SAVE verification procedures.

Clarifying information

Clients who are Federally Qualified (FQ) or Non-Federally Qualified (NF) are not eligible for AHE.

Clients who have not yet met their five-year bar are not eligible for AHE. This is due to being eligible for Qualified Health Plans with Advance Premium Tax Credits. These individuals could also be looked at for Alien Emergency Medical (AEM).

There are no retro benefits for AHE. If retro is requested staff may look at AEM for retro months.

AHE does not include long-term services and supports (LTSS) authorized by the Developmental Disabilities Administration (DDA), Aging and Long-term Supports Administration (ALTSA), or Home and Community Services (HCS) in the scope of care benefit package.

Clients also currently active on Medical Care Services (MCS) coverage are not eligible for AHE coverage as they would be dual-enrolled in coverage.

Classic Apple Health Expansion Worker responsibilities

Classic AHE applications are only processed by Community Services Division (CSD) specialized staff.

If the program cap has not been met, clients will be approved if eligible. If the limit (cap) is at capacity, eligible clients will be denied. Clients may qualify for other coverage including Alien Emergency Medical (AEM) and can purchase a QHP plan through the Health Benefits exchange (HBE).

DSHS-Classic Apple Health Expansion (S20)

DSHS-CSD processes AHE under Classic Apple Health when the individual is age 65 or older.

The following immigration status’ are eligible for AHE:

  • Undocumented / No immigration status
  • Applicants for asylum
  • Applicants for withholding of deportation/removal
  • Registry applicants
  • Order of supervision
  • Applicant for cancellation of removal / Suspension of deportation
  • Expired or revoked immigration status

Household composition-AHE (S20) will follow the same household composition rules as S02:

  • Income: Countable Earned and Unearned income types are the same as S02/S07 medical.
  • SSI recipient spouse: If an AHE applicant is married and their spouse is an SSI recipient, they are not eligible for AHE.
  • When there are two applying spouses on the same AU and they're eligible for different programs, only one spouse will be approved for coverage on the AU.

Example

  • John and Beth apply for medical on 7/1/24.
  • John is a 70-year-old citizen and Beth is 65 and does not have legal status.
  • A worker screens in S02 for John and S20 for Beth, with both clients having financial responsibility Applicant (PN).
  • During Finalize the S02 is approved for John with certification 7/1/24 - 6/30/25.
  • Beth's financial responsibility is changed from Applicant (PN) to Ineligible Spouse (SP).
  • During the finalize for the S20 John would be ineligible spouse (SP) and Beth would be applicant (PN).
  • If there is a spot available and Beth is eligible, she would be approved S20 on AHE.

Enrollment CAP

  • The CSD specialized medical team has cap override access in ACES. This field is displayed on the AU details screen in ACES 3G
  • All S20 requests processed after the cap has been met shall be denied for Reason Code (171) Enrollment Cap regardless of the date of application or when it was received as long as the AEM indicator = N and they aren't eligible for a Classic Medical Program. (Trickle to pending AEM if AEM indicator = Y.)

Asset Verification System (AVS)

  • S20 is not subject to asset test and therefore is required for AVS. S20 clients and AUs will not be included in the AVS application file. However, the AVS authorization field will display in ACES 3G when S20 is screened. If you have AVS authorization, update this field, if you do not, you are able to bypass.
  • AVS authorization field displays because if S20 trickles to S07. AVS authorization is required for S07 approval.

Submitting an application

DSHS Classic Apple Health Expansion

  • Staff screen in the application and can select the program code (S02, S20). Based on information entered in ACES, the program will trickle to the appropriate program.
    • Example: S02 is screened, but client is eligible based on immigration status and income for S20- ACES will trickle to S20
    • Example: S20 is screened, but based on immigration status and income entered the client is eligible for Federal Medicaid. S20 trickles to S99.

Attestation acceptance

Client attestation of all eligibility factors will be accepted.

Please report broken links or content problems.

Julie Colacurcio

Description
The agency is amending this rule to add language about data sharing between the Drug Price Transparency Program, the Prescription Drug Affordability Board, and the Health Care Cost Transparency Board to align with Engrossed Substitute House Bill 1508, Chapter 80, Laws of 2024, Sec. 2 (2)(a).

Agency contacts

Rulemaking contact

Melinda Froud

Program contact

Julie Colacurcio

Rulemaking status history

Preproposal (CR101)

Proposal (CR102)

  • WSR 24-24-052
  • Hearing Date: 1/7/2025
  • Registration is required to attend the public hearing.
    View the rulemaking's CR102 for the registration link.
  • Comments due by 1/7/2025

Permanent Adoption (CR103P)

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