WAC 182-521-0200 Coverage after the public health emergency (PHE) ends

WAC 182-521-0200 Coverage after the public health emergency (PHE) ends.

Effective September 1, 2023

  1. In response to the coronavirus (COVID-19) public health emergency (PHE) declared by the Secretary of the U.S. Department of Health and Human Services (HHS) and in response to Section 6008 of the Families First Coronavirus Response Act (Public Law 116-127), the medicaid agency:
    1. Continues your Washington apple health coverage unless your eligibility determination was made incorrectly, or you:
      1. Are deceased;
      2. Move out-of-state;
      3. Request termination of your coverage; or
      4. No longer meet citizenship or immigration requirements as described in WAC 182-503-0535.
    2. Waives and suspends the collection of premiums through the last day of the calendar quarter in which the PHE ends for:
      1. Apple health for kids with premiums (CHIP), as described in WAC 182-505-0215; and
      2. Health care for workers with disabilities (HWD) program, as described in WAC 182-511-1250.
    3. As required by Social Security Administration guidance, excludes permanently from resources federal, state, and local pandemic-related disaster assistance that has been retained.
    4. Excludes, for the duration of the PHE and a period of 12 months after the PHE ends, any resources not permanently excluded under (c) of this subsection and which accumulated from participation that did not increase in response to Section 6008(b) of the Families First Coronavirus Response Act (FFCRA), as described in WAC 182-512-0550 (24).
  2. Based on Section 5131 of the Consolidated Appropriations Act, 2023 (Public Law 117-328), effective April 1, 2023, if you receive continued apple health due to the suspension of certain eligibility rules during the PHE, the agency will, after April 1, 2023:
    1. Redetermine your eligibility for ongoing coverage using the process and timelines described in WAC 182-504-0035 and notify you as required under chapter 182-518 WAC. You may update any information needed to complete a redetermination of eligibility, as described in WAC 182-504-0035.
      1. If you are no longer eligible for apple health, or you do not respond to our renewal request notice, you will receive at least 10 calendar days' advance notice before your coverage is terminated, as described in WAC 182-518-0025.
      2. If your modified adjusted gross income (MAGI)-based coverage ends because you did not renew it, you have 90 calendar days from the termination date to complete your renewal. If you are still eligible for apple health, your benefits will be restored without a gap in coverage.
      3. If your coverage is terminated, you have a right to an administrative hearing, as described in chapter 182-526 WAC.
    2. Begin collecting premiums for CHIP and HWD clients prospectively, beginning with the month following the quarter in which the PHE ends, based upon reported circumstances, and without collecting arrears. 
    3. Resume eligibility verification based on the factors described in WAC 182-503-0050.

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.

WAC 182-513-1110 Presumptive eligibility (PE) - Long-term services and supports (LTSS) in a home setting authorized by home and community services (HCS).

WAC 182-513-1110 Presumptive eligibility (PE) - Long-term services and supports (LTSS) authorized by home and community services (HCS).

Effective January 6, 2024

  1. A person may be determined presumptively eligible for long-term services and supports (LTSS) in their own home, as defined in WAC 388-106-0010:
    1. Upon completion of a screening interview; and
    2. When authorized by home and community services (HCS).
  2. The screening interview described in subsection (3) of this section may be conducted by either:
    1. A HCS case manager or social worker;
    2. An area agency on aging (AAA) or their subcontractor; or 
    3. A state designated tribal entity.
  3. To be presumptively eligible (PE), the person must:
    1. Be determined to meet nursing facility level of care under WAC 388-106-0355 during the screening interview; and
    2. Attest to information that meets the:
      1. Income limits at or below the average monthly state nursing facility rate;
      2. Resource limits defined under WAC 182-513-1350;
      3. Social security requirement under WAC 182-503-0515;
      4. Residency requirement under WAC 182-503-0520; and 
  4. The agency or the agency's designee determines how much client responsibility must be paid to the provider for PE home and community-based services authorized by HCS when living at home as outlined in WAC 182-513-1215, 182-515-1507, and 182-515-1509.
  5. The client or the client's representative must submit an online application through Washington connection or an HCA 18-005 application for aged, blind, disabled/long-term care coverage to HCS within 10 calendar days of PE determination.
  6. The PE period begins on the date the screening interview is completed and:
    1. Ends on the last day of the month following the month of the PE determination if an LTSS application is not completed and submitted within 10 calendar days of PE determination; or
    2. Ends the last day of the month that the final eligibility determination is made if a LTSS application is submitted under subsection (5) of this section within 10 calendar days of PE determination.
  7. For application processing times, refer to WAC 182-503-0060.
  8. If the applicant is determined not financially eligible for LTSS under WAC 182-513-1315, there is no overpayment for services received during the PE period; however, client responsibility applies as described in WAC 182-513-1215, 182-515-1507, and 182-515-1509. 
  9. People who qualify for PE under this section receive categorically needy (CN) medical coverage under WAC 182-501-0060 through the PE period. CN medical coverage begins as described in WAC 182-503-0070 (1).
  10. When PE services described in WAC 388-106-1810 and 388-106-1820 are approved or denied, the agency or the agency's designee sends written notice as described in WAC 182-518-0010.
  11. A person may receive services under a PE period only once within a consecutive 24-month period.
  12. The applicant does not have a right to an administrative hearing on PE decisions under chapter 182-526 WAC.
  13. Institutional resource and income standards are found at https://www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply….
  14. This section does not apply to medical assistance programs described in WAC 182-507-0125 or 182-508-0005.

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.

Health savings accounts (HSAs) (non-Medicare)

HSAs are only available to members enrolled in a PEBB consumer-directed health plan (CDHP). You can use your HSA to pay for IRS-qualified, out-of-pocket medical expenses.

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Need to manage your HSA?

Visit HealthEquity

What is a health savings account (HSA)?

An HSA is a tax-advantaged account, which means money you contribute is not taxed. When you enroll in a CDHP, you are automatically enrolled in an HSA. The PEBB Program also contributes to your HSA each month.

With an HSA you can pay for:

  • IRS qualified out-of-pocket medical expenses (like deductibles, copays, and coinsurance) including some expenses and services that your health plans may not cover.
  • Qualified expenses for your spouse or other tax dependents, even if they aren't covered on your medical, dental, and vision plans.

Your HSA balance can grow over the years, earn interest, and build savings that you can use to pay for health care as needed. The money is yours, even if you change health plans.

After you’re 65, you can withdraw HSA dollars for any expense – you’ll just need to pay income taxes.

What is a consumer-directed health plan (CDHP)?

A CDHP is a high-deductible health plan (HDHP), with a health savings account (HSA). CDHPs offer lower premiums, a higher medical deductible, and a higher medical out-of-pocket limit than most traditional health plans.

Kaiser Permanente NW, Kaiser Permanente WA, and Uniform Medical Plan offer CDHPs. Visit benefits and coverage by plan for coverage details.

Other features

  • If you cover yourself and one or more dependents, you must pay the entire family medical deductible before the plan begins paying benefits.
  • Your medical and prescription drug costs count toward the annual deductible and out-of-pocket maximum.

Contributions

Call HealthEquity to set up direct deposits to your HSA. You may be able to deduct your HSA contributions from your federal income taxes.

To make sure you do not go beyond the limit, consider the PEBB Program's contributions, your contributions, and the SmartHealth wellness incentive in January (if you qualify). Use the HSA contribution calculator.

Your contributions

The IRS has annual limits for contributions from all sources into an HSA.

  • For 2026, the contribution limit for an HSA is $4,400 (subscriber only), and $8,750 (subscriber and one or more dependents).
  • For 2025, the contribution limit for an HSA is $4,330 (subscriber only) and $8,550 (subscriber and one or more dependents).
  • Members ages 55 or older, you may contribute up to $1,000 more annually in addition to these limits.
Employer contributions

After your HSA is established with HealthEquity, you can start to receive employer contributions.

The contribution goes into your HSA in monthly installments over the year on the last day of each month (the entire HSA amount is not available on January 1).

The Health Care Authority will contribute the following amounts to your HSA:

Just you

  • Monthly: $58.34
  • Total deposited by the end of the year: $700.08

You and your family

(If you have at least one other family member on your CDHP, you qualify for the family contribution.)

  • Monthly: $116.67
  • Total deposited by the end of the year: $1,400.04

You will get an additional $125 in your HSA (deposited at the end of January in the following calendar year) if you qualify for the SmartHealth wellness incentive.

Eligibility

You must meet certain eligibility requirements to enroll in a CDHP with an HSA. If you (the subscriber) are not eligible and enroll, you may be liable for tax penalties.

To be eligible to enroll in a CDHP, you cannot be enrolled in:

  • Medicare Part A or Part B
  • Medicaid.
  • Another health plan that is not an IRS-qualified high-deductible health plan — for example, on a spouse’s or state-registered domestic partner’s plan — unless the health plan coverage is limited coverage, such as dental, vision, or disability coverage.
  • A Voluntary Employee Beneficiary Association Medical Expense Plan (VEBA MEP), unless you convert it to a limited health reimbursement account (HRA) coverage. (This includes you or your spouse or state-registered domestic partner.)
  • A CHAMPVA plan.
  • A TRICARE plan.
  • A fully claims-eligible health reimbursement arrangement (HRA), such as a Voluntary Employees' Beneficiary Association (VEBA) plan. However, you may enroll in a CDHP if you convert your HRA to "limited HRA" coverage by submitting a Limited HRA Coverage Election form to your VEBA plan.
  • A Flexible Spending Arrangement (FSA). This also applies if your spouse has an FSA, even if you are not covering your spouse on your CDHP. This does not apply if the FSA is a limited purpose account or a post deductible FSA.
  • You also cannot be claimed as a dependent on someone else’s tax return.

Other exclusions apply. Check IRS Publication 969—Health Savings Accounts and Other Tax-Favored Health Plans, contact your tax advisor, or call HealthEquity toll-free at 1-877-873-8823(for Kaiser members) or 1-844-351-6853 (for UMP members) to verify whether you qualify. See The Complete HSA Guidebook for full details.

You cannot be enrolled in a CDHP and Medicare

If you are enrolled in a CDHP when you or a covered dependent becomes entitled to Medicare Part A and Part B, you must choose a new medical plan that is not a CDHP. The PEBB Program must receive your request no later than 60 days after the Medicare enrollment date.

What happens to my HSA when I leave the CDHP?

If you choose a medical plan that is not a CDHP you should know:

  • You won’t forfeit any unspent funds in your HSA after enrolling in a different plan. You can spend your HSA funds on qualified medical expenses in the future. However, you and the PEBB Program can no longer contribute to your HSA.
  • HealthEquity will charge you a monthly fee if you have less than $2,500 in your HSA after December 31. You can avoid this charge by either ensuring you have at least $2,500 in your HSA or by spending all of your HSA funds by December 31. Other fees may apply. Contact HealthEquity for details.
  • If you set up automatic contributions to your HSA through HealthEquity, you must contact them to stop the deductions.

Apple Health (Medicaid) and managed care reports

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Apple Health managed care plans

Apple Health (Medicaid) contracts with five organizations who serve both as Managed Care Organizations (MCO) and Prepaid Inpatient Health Plans (PIHP):

Accountability in managed care

Managed care report cards

Apple Health Plan Report Card

This report card shows how Washington Apple Health managed care plans compare to each other in key performance areas. The report card can be used as a guide to select a health plan for Apple Health coverage.

Performance areas Coordinated Care Community Health Plan of Washington Molina Healthcare of Washington UnitedHealthcare Community Plan Wellpoint Washington
Getting care ★★☆ ★★☆ ★★☆ ★★☆ ★☆☆
Keeping kids healthy ★★☆ ★★☆ ★☆☆ ★☆☆ ★☆☆
Keeping women and mothers healthy ★★★ ★★☆ ★★☆ ★☆☆ ★☆☆
Preventing and managing illness ★☆☆ ★★☆ ★★☆ ★☆☆ ★☆☆
Ensuring appropriate care ★★★ ★★★ ★☆☆ ★☆☆ ★☆☆
Satisfaction of care provided ★★☆ ★★☆ ★★☆ ★★☆ ★★☆
Satisfaction with plan ★★☆ ★★☆ ★★☆ ★★☆ ★★☆

View the 2025 Apple Health Plan Report Card for more information.

Past Apple Health plan report cards

Value-Based Payment (VBP) Quality Report Card

This report card shows how Apple Health plans preformed in year 2024 and identifies where plans have met the criteria for the return of withhold dollars for the quality performance measure part of the value-based purchasing strategy.

View the 2025 Value-Based Payment Quality Report Card.

Managed care

Value-based payment measure Coordinated Care Community Health Plan of Washington Molina Healthcare of Washington UnitedHealthcare Community Plan Wellpoint Washington
Total percent achieved 100% 85.7% 100% 85.7% 85.7%

Foster care

Apple Health Integrated Foster Care VBP measure Coordinated Care
Total percent achieved 66.7%
Past value-based payment report cards

National Committee for Quality Assurance (NCQA) accreditation

Washington State Apple Health managed care organizations (MCOs) are required to have and maintain NCQA accreditation. Below is each plan and their NCQA accreditation status.

Additional report information is available using the NCQA Health Plan Report Card search.

NCQA Accreditation Community Health Plan of Washington Coordinated Care Molina Healthcare of Washington UnitedHealthcare Community Plan Wellpoint Washington
Rating Three and a half stars Three and a half stars Three and a half stars Three and a half stars Three and a half stars
Accreditation Type Health Plan Health Plan Health Plan Health Plan Health Plan
Plan Type Medicaid HMO Medicaid HMO Medicaid HMO Medicaid HMO Medicaid HMO
Status Accredited Accredited Accredited Accredited Accredited
Distinction Health Equity Accreditation Health Equity Accreditation Health Equity Accreditation Health Equity Accreditation Health Equity Accreditation
Health Equity Accreditation Plus

Apple Health managed care quality reports

Managed Care Quality Strategy
Annual EQR Technical Report
Annual Comparative Analysis Reports
Consumer Assessment of Healthcare Providers and Systems (CAHPS) reports

HCA uses surveys and other data collection to help measure Apple Health clients' experience with their health plans.

Adult

Child

Parity analysis

Managed care plan enrollment

Most Apple Health clients are enrolled in a managed care plan. The following reports are for the Apple Health managed care population:

Managed care program annual reports (MCPAR)

Integrated foster care (IFC)
Integrated managed care (IMC)

State Directed Payment Evaluations

State Directed Payments (SDP)

State Directed Payments (SDPs) are a tool that allows Washington to direct Managed Care Organizations (MCOs) to provide targeted rate increases that support specific populations, providers, or types of care. These payments help strengthen provider networks, promote innovation, and improve the quality and efficiency of Medicaid services.

New federal rules now require all SDPs to include a quality evaluation plan that measures their impact on care outcomes. Washington’s SDP quality evaluations use data-driven measures aligned with the state’s Managed Care Quality Strategy to assess whether these payments are meeting the state’s goals and improving care for Medicaid enrollees. Read the fact sheet to learn more about SDP's.

Evaluations

Apple Health client eligibility dashboard

The client dashboard is an interactive tool that helps answer questions about Apple Health eligibility.

How to use the dashboard

The following instructions demonstrate several ways to use the dashboard.

How to see people by county

Option 1: From the dropdowns on the left:

  1. Select the month.

  2. Select a program. (All) is the default.

  3. Select a county or leave the selection as default.

The dashboard will automatically refresh with the choices you select. Be sure to click Apply at the bottom of each dropdown to complete the selection.

Option 2:From the tabs at the top of the screen (above the HCA logo):

  1. Select Apple Health Client Map.
  2. Select a month from the dropdown on the left.

How to see a 12-month summary

  1. On the dashboard select month dropdown, choose most recent 12 months.
  2. Select Apply.
  3. Use other available filters to refine data further.

How to see eligible children

In the Select a program dropdown:

  1. Select Apple Health for Kids.
  2. Select Apply.
  3. Use other available filters to refine data further.

COVID-19 Public Health Emergency Demonstration - Evaluation

This report covers the demonstration period from March 2020 through July 2023. Centers for Medicare and Medicaid Services (CMS) determined that the Final Report, submitted on May 19, 2025, is in alignment with the CMS-approved Evaluation Design, and therefore, approves the state’s Final Report.

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