A Brief Overview
- Medicaid is state-run health care for those with limited income or individuals with chronic or complex health care needs with special circumstances.
- Medicaid is available to many families In Washington state who are not eligible for Medicare and are below certain income levels.
- Apple Health for children has broader eligibility requirements, meaning that more children in Washington state can be covered for low or no cost.
- You can apply for Medicaid through the Washington Health Plan Finder.
Full Article
Medicaid is a federal health care program that each state manages based on their own states legislative system. It is set up for individuals and families with limited income or special circumstances such as a genetic, medical, or job or accident-related disability. This health care covers physical and mental health and can be low to no-cost. To be eligible for fully subsidized (free) Medicaid you must meet the household income eligibility and not be eligible for Medicare. However, Medicaid for those with Medicare can help with some expenses not covered by Medicare for those with low income. It is available for an individual on classic Medicaid whose parent or guardian has died and whose benefits pass to their child. In the state of Washington, Medicaid is generally known as Apple Health and is administered by the Health Care Authority.
There are two main types of Medicaid available in the state of Washington: Apple Health (income based), and Classic Medicaid. The day-to-day administration of Apple Health and Classic Medicaid is run by one of five Managed Care Organizations, or MCOs. Apple Health covers individuals up to the age of 6 and eligibility is based on household income. Apple Health has higher income limits for children than adults, meaning that many children in Washington State are eligible for free Apple Health, even when their parents or guardians are not.. If you have Apple Health, you will get healthcare from the providers at one of those MCOs. If you are found (determined) to have a disability or a disabling medical condition and are under the age of 65, you are eligible for Classic Medicaid if you are on Social Security Income or Supplemental Security Income (SSI). This is also considered Apple Health and under one of the 5 MCOs. If an infant, child, or youth through age 21 is in the foster care system they will be covered by Apple Health and will get their healthcare from one specific MCO no matter where they live in the state.
Determining Eligibility for Apple Health
Apple Health has different eligibility requirements for children and adults. These differences are listed below, including the maximum monthly household income requirements that families may have to obtain coverage.
Eligibility for Apple Health for Children:
- Children of public employees with access to health insurance coverage under the PEBB or SEBB programs are not eligible for Apple Health for Kids with premiums.
- Low-cost coverage (Apple Health with premiums) is only available to children who are uninsured when household income is too high to qualify for free Apple Health (no premiums)
- Income requirements for free coverage: (2024)
| Single Person | 2-Person Household | 3-Person Household | 4-Person Household | 5-Person Household | 6-Person Household | 7-Person Household | |
| Apple Health for Kids | $2613 monthly | $3534 monthly | $4455 monthly | $5375 monthly | $6296 monthly | $7217 monthly | $8138 monthly |
- Income requirements for Tier I subsidized coverage ($20 monthly per child; $40 family maximum):
| Single Person | 2-Person Household | 3-Person Household | 4-Person Household | 5-Person Household | 6-Person Household | 7-Person Household | |
| Apple Health for Kids Tier I | $3220 monthly | $4355 monthly | $5490 monthly | $6625 monthly | $7761 monthly | $8896 monthly | $10031 monthly |
- Income requirements for Tier II subsidized coverage ($30 monthly per child; $60 family maximum):
| Single Person | 2-Person Household | 3-Person Household | 4-Person Household | 5-Person Household | 6-Person Household | 7-Person Household | |
| Apple Health for Kids Tier II | $3852 monthly | $5210 monthly | $6568 monthly | $7925 monthly | $9283 monthly | $10641 monthly | $11999 monthly |
Eligibility for Apple Health for Adults:
- For those aged 19 through 64.
- For U.S. citizens or those who meet Medicaid immigration requirements. (Including Washington residents from the Republic of Palau, the Republic of the Marshall Islands, and the Federated States of Micronesia)
- For those who are not entitled to Medicare.
- Have annual household income at or below the Medicaid standard:
| Single Person | 2-Person Household | 3-Person Household | 4-Person Household | 5-Person Household | 6-Person Household | 7-Person Household | |
| Apple Health for Adults | $1677 monthly | $2268 monthly | $2868 monthly | $3450 monthly | $4042 monthly | $4633 monthly | $5224 monthly |
How to Apply
There are a couple of ways to start the process of getting Medicaid or other subsidized health care plans. The Health Insurance Marketplace Calculator provides estimates of health insurance premiums and subsidies for people purchasing insurance on their own in health insurance exchanges or “Marketplaces.” The Washington Health Benefit Exchange can help families and individuals find subsidized health care in their area.
When ready to apply for coverage from Apple Health:
- Read the Eligibility Overview to determine if Apple Health is the best fit for you and your family.
- Create an account on Washington Health Plan Finder.
- Collect and enter information into the Washington Health Plan Finder application, WAPlanfinder Mobile App, downloadable paper form, or call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633.
- Review the five Integrated Health Care Plans responsible for Medicaid in Washington, not all of which may be available in your location.
- If you need further help, contact a free Health Plan Navigator.
To get signed up with Medicaid Classic, go online to Washington Connection and select “Apply Now,” or call 1-877-501-2233. For additional help signing up for Medicaid in Washington, help is available from Parent help 123, which can be contacted at 1-800-322-2588, or PAVE. If, in looking at the information above, you feel that you or the person you care for has lost Medicaid through a mistake or a problem with the system and going through the Washington Connection is not resolving the issue, the Federal Government is asking that you go through Healthcare.gov to get help with re-enrollment.