Washington Medicaid Eligibility and Enrollment
- Washington Medicaid provides health coverage to qualifying residents. Learn more about what the program covers and how to apply in this in-depth guide.
What Is Washington Medicaid?
Washington Medicaid pays for low-income residents to receive medical and behavioral care services provided by professionals throughout the state. Known as Apple Care, Washington's Medicaid program covers a wide variety of services, including preventive care, diagnostic screenings and treatment for acute and chronic illnesses.
How Does Medicaid Work in Washington State?
In Washington, most Medicaid recipients are covered by a managed care plan, which combines medical services and behavioral health services in a single package. Apple Health pays the monthly premium for this plan, giving low-income residents access to the care they need to stay healthy and maintain their quality of life.
Five organizations offer Apple Health plans: Amerigroup, Community Health Plan, Coordinated Care, Molina Healthcare and United Healthcare. Plan availability depends on an individual's county of residence. Amerigroup is available to residents of every county in Washington; in contrast, United Healthcare only offers Apple Health coverage in 17 of the state's 39 counties.
Apple Health also has a fee-for-service program, under which doctors and other health care providers are paid directly by Washington Medicaid. Some enrollees receive fee-for-service coverage without having a managed care plan. Apple Health clients may also use fee-for-service benefits to pay for services that aren't covered by their managed care plans.
Services Covered By Apple Health
The federal government requires each state Medicaid plan to cover a basic set of services, which are known as mandatory benefits. According to the guidelines, physician services, laboratory tests, X-rays, inpatient hospital care and home health services, among others, must be covered. States are also allowed to cover optional services, such as prescription medications and occupational therapy. The following are some of the services covered by Apple Health in Washington:
- Hearing aids
- Home health services
- Maternity care
- Hospice services
- Organ transplants
- Services provided by a nursing facility
- Prescription drugs
- Reproductive health care
- Vision care
- Medical equipment and supplies
Who Is Eligible for Medicaid in Washington?
Adults between the ages of 19 and 64 must meet the following requirements:
- Washington resident
- S. citizen or lawful immigrant
- Ineligible for Medicare
- Income at or below the monthly limit
Adults who have reached the age of 65 may qualify for Apple Health Classic in addition to their Medicare benefits. Some individuals don't qualify for Apple Health Classic, but they do qualify for help paying monthly Medicare premiums. Adults in this age group must meet the same citizenship, residency and income requirements as younger adults.
Older adults (65+) who continue to work may qualify for the Apple Health for Workers with Disabilities program, which provides Apple Health coverage to individuals who are blind or have other disabilities but still have some earned income. Under the Apple Health for Workers with Disabilities program, covered individuals pay premiums based on their income. This program has no upper income limit.
For older adults with extremely limited income and at least one qualifying disability, Apple Health offers Medicaid coverage with income limits that are lower than the limits for adults between the ages of 19 and 64.
What Is the Income Limit for Washington Apple Health?
For adults between the ages of 19 and 64, the income limits for Apple Health are as follows:
|
Household Size |
Monthly Income Limit |
|
1 |
$1,677 |
|
2 |
$2,268 |
|
3 |
$2,859 |
|
4 |
$3,450 |
|
5 |
$4,042 |
|
6 |
$4,633 |
|
7 |
$5,224 |
For adults aged 65 and older who have blindness or another disability, the monthly income limit is $914 for a single person and $1,371 for a two-person household.
How Do I Enroll in Medicaid in Washington?
Apple Health offers several application methods for Washington residents in need of coverage. Interested individuals should gather proof of their residency, income and citizenship status before starting the application.
Application Methods for Adults 19-64
- To apply online, visit Washington Healthplanfinder and click the Apply Now button.
- Washington Healthplanfinder is also available as a mobile app. To fill out an application on a smartphone or tablet, download the app and provide the requested information.
- Contact the Washington Healthplanfinder Customer Support Center to apply via telephone. The telephone number is (855) 923-4633.
- Applicants who prefer to apply in person should use the Washington Healthplanfinder website to find a local navigator. A Washingtonhealthplan finder account is required to communicate with a navigator regarding Apple Health coverage.
Application Methods for Adults 65+
- To apply online, visit Washington Connection and click the Apply Now button.
- A paper application is available on the Washington State Health Care Authority website. Completed applications should be mailed to DSHS Community Services Division - Customer Service Center, PO Box 11699, Tacoma, WA 98411-6699.
- Request an Apple Health Classic application by telephone at (877) 501-2233.
- Applicants who prefer to apply in person should visit a local Department of Social and Health Services office. DSHS maintains a list of local offices on its website.
Contact Information for Washington Medicaid
Contact Apple Health Customer Service at (800) 562-3022.
