Tag: children

Medicaid Basics

Posted on by Nicol Walsh

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.
  • Major Changes are in effect for 2027

Medicaid is a federal health care program that each state manages based on their own states legislative system. Washington’s Medicaid program is set up for individuals and families with limited income or that have 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-cost or 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 Managed Care Organizations, or MCOs. Apple Health covers all individuals up to the age of 6. After that, 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 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.

Recent changes to Medicaid have changed several elements of Apple Health. Eligibility changes for adults are explained below and relate to citizenship status and work status. Adults will have to renew their coverage twice a year, including submitting eligibility documents, instead of once a year.

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: (2026)
ServiceSingle Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Kids $2,860
monthly 		$3,879
monthly 		$4,896
monthly 		$5,913
monthly 		$ 6,932
monthly		$ 7,949
monthly
$ 8,966
Monthly

Income requirements for Tier I subsidized coverage ($20 monthly per child; $40 family maximum): 

 ServiceSingle 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 $3,525 monthly $4,781
monthly 		$6,034
monthly 		$7,288
monthly 		$8,544
monthly 		$9,797
monthly 		$11,051 monthly 

Income requirements for Tier II subsidized coverage ($30 monthly per child; $60 family maximum): 

 ServiceSingle 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 $4,216 monthly $5,719
monthly 		$7,218
monthly 		$8,718
monthly 		$10,220
monthly 		$11,719
monthly 		$13,219
monthly 

Eligibility for Apple Health for Adults:

Eligibility for Apple Health for Adults: 

 ServiceSingle Person 2-Person Household 3-Person Household 4-Person Household 5-Person Household 6-Person Household 7-Person Household 
Apple Health for Adults $1,835 monthly $2,490
monthly 		$3,142 monthly $3,795 monthly $4,449 monthly $5,102
monthly 		$5,755
monthly 

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:

  1. Review adult and/or child income and other eligibility requirements.
  2. View what services are provided through Apple Health to see if it the best fit for you and your family.
  3. Create an account on Washington Health Plan Finder.
  4. Collect and enter information into the Washington Health Plan Finder application,  downloadable paper form, or call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633. Review the Integrated Health Care Plans responsible for Medicaid in Washington, not all of which may be available in your location.
  5. 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 Help Me Grow Washington, 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.

Keeping Kids Busy Through Summer: Summer Camp Alternatives

Posted on by Nicol Walsh

Summer camp is an excellent way for children to spend the long summer days. However, camps often fill quickly, and many are too expensive for families. Here are some alternatives to summer camps to entertain children and give caregivers some much needed respite.

A Brief Overview

  • There are many inexpensive ways to entertain children over the summer 
  • Check with local parks and recreation for activities, including those for children and youth with disabilities 
  • Washington State Parks are wonderful for families to explore 
  • Check with family organizations, schools, and teachers for ideas and information on programs 

Full Article

Local parks and recreation departments often increase children’s activity programs for the summer. These can include sports, preschool classes, and outdoor activities. Some of the parks and rec departments, especially in larger communities, have adaptive or accessible classes, for those with disabilities and/or sensory issues. Cities and towns who have parks and recreation departments usually have information on the city or town website, or you can call the city or town main office. Some counties have similar programs, both summer and year-round. Check out the county website (usually the name of the county plus “.gov”). 

Several national non-profits have low-cost options for families during the summer, and year-round. Boys and Girls Clubs have activities, classes, and day camps, and membership fees are on a sliding scale. Their Find a Club interactive map will let you locate the nearest club. The YMCA may offer day camp options, along with their usual sports and recreation options. They have scholarships to help pay for enrollment and camps. 4H, the nation’s largest youth development organization, has many opportunities for children and youth to engage in hands-on learning, skill building, and community interaction. Various branches of 4H offer Science, Technology, Engineering & Math (STEM) activities, civic engagement, animal science, environmental science, performance arts, nutrition and health, and many, many more activities are available through your local camps. 

Washington State Parks provide for a wide range of outdoor activities this summer and even have special events that can be viewed on their calendar. For children four and up, the Junior Ranger Program has activities to print out, along with ideas for indoor and outdoor fun. For those with physical limitations, an interactive ADA map of park facilities shows the wheelchair accessible options throughout the State Park system. 

Libraries often have surprisingly varied options, including reading programs, arts and crafts, educational classes, and movie nights. Many libraries now have take-home kits for creative activities to do with the whole family. Summer reading lists are available both on library websites and in-person. A full listing of libraries in the state is available from library technology. 

Movie theaters sometimes offer sensory-friendly film viewing at certain scheduled times, check with the theater. Good for those hot afternoons! Information about these screenings can be found on the websites of the theatres, including major chains such as AMC and Regal. 

Parent groups and family organizations are often up to date on the latest summer activity offerings around the community. The Arc of Washington and Parent to Parent are both focused on families with children with disabilities or special health care needs, are aware of many opportunities, and may even offer some events for families and kids.  

Some school districts have enrichment activities over the summer beyond the extended school year (summer school) options. Local school district websites will have full listings for anything they may offer. Often schools and school districts also have recommendations for summer activities and information on summer events. Teachers are a useful resource for summer ideas and information, as they have heard a lot about what their students are doing this summer, so a quick chat with them may be in order. 

Several websites focus on community events and classes that children and youth can be involved in over the summer. The most prominent is Macaroni KID, but others include Parent Map, and Family Day Out. The local Chamber of Commerce and local newspapers will also post some event highlights and may list on their community calendars. Summer is also the time for County Fairs and other events, many of which take place in August. 

There are children’s museums, large and small, around the state. They have increased offerings during summer months; some even have camps. Most are geared towards younger children through elementary school age. The most prominent museums include the Seattle Children’s Museum, the Hands On Children’s Museum of Olympia, the Imagine Children’s Museum in Everett, the Children’s Museum at JBLM, Children’s Museum of Tacoma, KidsQuest Children’s Museum in Bellevue, KiDiMu on Bainbridge Island, Children’s Museum of Skagit County, Tree Fort Children’s Museum in Moses Lake, and the Children’s Museum of Walla Walla. 

Lifespan Respite WA (a program of PAVE) has a list of registered providers that is accessible to everyone, where it is possible to find recreation and respite options by county, age served, disabilities served, and respite type. The options listed under Recreation on the “Respite Type” menu has an array of interesting options that may have flown under a family’s radar, such as equine therapy, music classes, and sensory-friendly playgrounds. Check out their page “Creative Options for a Respite Break” for more low-cost and free ideas for summer (and year-round) activities. Visit their How to Apply for Respite page to find out if you qualify for a small grant for short respite breaks! 

Lifespan Respite WA for Professionals: Social Services and Medical

Posted on by Barb Koumjian

What Lifespan Respite WA does:

We offer interpretation if arranged in advance for almost any language. Email us in a preferred language to set this up.

Contact us:     Email: getrespite@wapave.org; Phone:  253-442-3214

Essential Information

  • Caregivers must not be receiving respite care funded through any other program or organization, whether government-funded or private sector. Family helping out by paying for respite care doesn’t count as “paid respite”. (On the other hand, families who are approved for publicly funded programs, but who won’t get services for at least 30 days or on a no-paid-services list are eligible for a Lifespan voucher).
  • We do not ask for any proof of condition or diagnosis, any proof of income, or any documentation. Everything is self-reported.
  • We are required to get a statement (emailed, texted) from a caregiver if the care recipient is on Medicaid, that no paid respite is being received from any program or agency. Financial help from family members is ok.
  • This program is for PLANNED, not crisis or emergency respite. No exceptions.
  • Short-term!! Must use within 4 months, unless for summer camps or recreation. In that case, proof of registration is required.
  • Extensions may be approved under compelling circumstances, on a case-by-case basis.
  • Usual award amount is $1,000.00 per household.
  • ONE voucher per household—if there are multiple care recipients, voucher is evenly split and can’t be transferred from one family member to another.
  • There is a wait list since there are always more applications than funds. We cannot tell exactly when an award will be made. According to our contract with the state, vouchers are given based on the date of application, but also on an equitable distribution of vouchers across WA State, taking into account the population density and numbers of applications from different regions.
  • Applicants get an email notice when we get their application. We will be sending interim notices to let applicants know their application is still on the list
  • Caregivers can reapply in one year from the date of their most recent application.
  • Caregivers have the responsibility to find out the hourly or session rate charged by the program or agency, and to keep track of hours or sessions so as not to run over the voucher amount. Caregivers are financially responsible for any charges over the amount of the voucher.

Important for family caregivers to know

  • The biggest barrier to voucher use, for many caregivers, appears to be contacting programs or agencies and persisting until they get a response back. This is why we recommend checking providers out even before a voucher is awarded. Check our “List of Providers” page to find out if the type of respite they have in mind is available in their area.
  • There is no guarantee that any program or agency has availability even when on our Providers list.
  • We have providers of some type in each county in WA; but some counties do not have much provider choice. We are constantly working on that!
  • Voucher applicants may suggest a provider if there is no availability among the registered providers, or if they have requirements registered providers cannot meet. The team will reach out and see if the suggested provider is willing to take the voucher funding.
  • We can’t pay a family member OR ANY OTHER INDIVIDUAL to be a caregiver. The only respite we will pay for is from one of our Registered providers.

Respite Offers a Break for Caregivers and Those They Support

Posted on by Nicol Walsh

Respite offers a short-term break for caregivers and those they support. This article provides information and resources to get started seeking respite services. Resources and links include sources of respite in WA State.

A Brief Overview

  • What family caregiving is
  • What respite care is, and why it’s important for family caregivers
  • Types of respite
  • How to decide on the best type of respite services for your family
  • Free and low-cost respite in WA State, including links to Veterans Administration and options for active duty military families.
  • Paying out-of-pocket for respite in WA State

What is family caregiving?

Modern families come in many styles. The primary caregivers of a person with a disability or special health care need might be parents or spouses or adult children, and they might be other relatives (kinship caregivers), friends, or neighbors.

They can also be described as “family caregivers”. This term is used widely by social service professionals, medical providers, and organizations and agencies that offer respite services and decide on respite care eligibility.

Some professionals use the term “care recipient” to describe the person who needs care from the family caregiver. However, in this article we will use the term “loved one” or “loved ones”, because family caregivers are usually not paid workers providing a service. They give care because families love and care for one another, and because “That’s what family is for”.

What is respite care? Why is it important for family caregivers?

Respite care is a short break from caregiving tasks for the family caregiver. It might last a few hours or include 24-hour a day care that lets the family caregiver (s) have a vacation.
Family caregiving can create deep bonds, be emotionally fulfilling and full of loving acts of kindness. It’s also physically, emotionally, and mentally tiring. Family caregivers don’t just run errands or do housecleaning for loved ones; they organize medical care, take loved ones to appointments, provide personal hygiene, handle finances, arrange after-school and childcare, wrestle with health insurance companies, Apple Health, or Medicare, and may have legal responsibilities such as being a court-appointed guardian or an agent under a Durable Power of Attorney.  

These responsibilities often add up to a full-time job in addition to paid employment and caring for other family members.  Respite breaks from caregiving are one of the top requests family caregivers make when they apply for caregiver supports and benefits, along with financial help. 

Family caregivers often wait until they are burnt out before looking for respite care. They may not realize it’s available for their situation, or their loved one may not like the idea of getting help from anyone but family. Putting everyone else’s needs before your own can take care of an immediate problem; in the long term, it can lead to increased anxiety, frustration, resentment, depression and even illness. Whether you think of yourself as a family caregiver or not, these are all signs of caregiver burnout and stress.

Time apart can boost well-being for both the family caregiver and their loved one. While caregivers temporarily shift their focus to necessary self-care, loved ones can meet new people and explore new interests.


What respite services would be most helpful?

Respite includes a wide variety of programs and services, such as:

  • In-Home Services (errands, light chores, personal care, companionship, medication reminders, etc.) *
  • Recreation (sports, exercise, crafts, and other leisure activities)
  • Day or Overnight Camps which serve individuals with disabilities
  • Day Services (dementia or memory centers, after-school and weekend programming for adults, children, and youth, daycares, etc.)
  • Education/Classes (may include preschools, nature schools, art, music, recreational skills, academics, etc.)
  • Organizations offering therapeutic benefits for a loved one (social skills groups, music therapy, equine/animal therapy, etc.)
  • 24-hour care

* In-home respite care does not include services that need to be performed by a nurse, occupational therapist or physical therapist. Some home-care agencies can provide services from those professionals, but most of the time, such services are arranged for and covered by health insurance.

Tools can help you decide which type or types of respite will work for you and your family:

Washington’s Pathways to Respite booklet includes “fill-in-the-blanks” tools to help define needs, like these examples:

“I would like to take a break, but I am concerned that___________” and “If I had some time to myself, I would _____________.”

This respite planning guide is from the Veterans Administration, but can work for any caregiver, civilian or military: https://www.caregiver.va.gov/CAREGIVER/support/docs/docs2024/Caregiver-Respite-Tool-2022.pdf#.

Ways to pay for respite and find respite providers:

If a family will pay out of pocket for respite services, they can find respite providers online. Here are some ideas to start a search:

  • “Adult Day Services Washington State”
  • “After-school programs children with special health care needs Washington State”
  • “In-home care agencies near me”
  • Check the listings at Lifespan Respite WA; listed agencies meet state standards for background checks and liability insurance.

Care.com is a paid private, online service connecting respite or personal care workers with potential care recipients and their families. Families are on their own to follow up on an individual worker’s qualifications, references, and background, although some listings will show someone has passed a background check. This service requires payment and a subscription, but it is easy to cancel once a caregiver has been hired. They also offer a program to manage tax withholding and payments for the independent workers hired.

If a care recipient is eligible for respite through private medical insurance, the insurance company will list approved providers or caregivers may call their insurance company representative.

When researching a respite agency, caregivers can check whether the agency meets standards and follows appropriate safety measures.

Here are a few examples of questions you might ask:

  • How are the workers chosen and trained?
  • Can the respite worker give medicine or help with medical tasks?
  • How are emergencies and problems handled?

A thorough guide is available at the ARCH National Respite Network and Resource Center: How to Choose a Respite Provider.

Free and low-cost respite services:

In Washington State, eligibility for free or low-cost respite services may depend on the caregiver or loved one’s circumstances or category of disability.

Seniors and Adults with Disabilities

Seniors 65 and older who meet functional and financial eligibility can get a variety of services through Department of Social and Health Services Home and Community Services Administration (HCSA).

Unpaid (family) caregivers of adults who are 55 and older who meet functional and financial eligibility can get respite care and other needed support services like caregiver education, support groups, housework and errands and other services.

The easiest way to learn about services and eligibility is to contact the county or regional Area Agency on Aging, which administers many of HCSA’s services. They are also listed at Washington’s Community Living Connections/waclc.org.

Some programs are:

Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA), Medicaid Demonstration Projects funded through Department of Health. Information and applications are handled through the Aging and Disability Resource Centers/Are Agencies on Aging (DSHS). These are WA’s most direct programs for unpaid family caregivers of people age 55 and older. They fund caregiver’s needs including respite care, caregiver training, and supplies. MAC serves people who are Medicaid-eligible but choose not to enroll in CFC. TSOA serves people who are not financially eligible for Medicaid, with higher income and asset limits, and does not require an unpaid caregiver.

As of September 2026, these programs have an automatic waitlist. Check back with the agency where you applied for updates.

Family Caregiver Support Program (FCSP)  An eligible caregiver is a spouse, relative, or friend who has responsibility for the care of an adult with a functional disability and does not receive financial compensation for the care provided. This program is administered by Aging and Disability Resource Centers/Area Agencies on Aging across the state. Respite funds vary by source, and availability of respite funding varies by location.

Catholic Community Services in WA are non-denominational in the services they offer. In addition to in-home supports, many other community/social service programs are available such as housing support, mental health support and treatment, food and financial assistance, teen and youth support, and more.

Catholic Community Services of Western WA

Catholic Charities of Central WA

Catholic Charities Eastern WA

Don’t forget to look in your community and nearby for memory cafes, volunteer-based dementia or disability day programs, and senior center offerings!

Respite for All Ages:

American Indian and Alaska Native Caregivers:

Lifespan Respite WA Voucher Programis open to all eligible American Indian and Alaskan Native caregivers.

Contacts for Tribal programs in WA State can be found on the HCLA Tribal Affairs website at Washington’s Department of Social and Health Services (DSHS). Individual Tribes direct their own caregiving and/or respite programs.

Community First Choice (CFC): your loved one is eligible if:

  • Financial Eligibility: must be financially eligible for Medicaid (Apple Health)
  • Functional Eligibility: require an “institutional level of care” (such as nursing home placement or an intermediate care facility) but choose to receive care at home or in an alternative living facility.
  • Medicaid Enrollment: Must be enrolled in Washington Apple Health (Medicaid) under a categorically needy (CN) or alternative benefit plan (ABP) scope of care.
  • If your loved one is age 65 or older, blind, disabled, or on Medicare, apply at WashingtonConnection.org.
  • If your loved one is under age 65 or not eligible for Medicare, apply using the WA HealthPlan Finder.
  • You can also apply in-person at a local Home and Community Services office.

COPES: a wraparound service for individuals on the Community First Choice plan. Individuals must have needs that exceed what is available in Community First Choice. Eligible individuals are in the Community First Choice Program. 

Home and Community-Based Services for individuals with developmental disabilities, which may include respite for their caregivers (through the Developmental Disabilities Administration/DDA)

Eligibility is based on the presence of one of four developmental disabilities (Intellectual disability, Cerebral palsy, Epilepsy, Autism) or associated disabilities, an age of onset prior to diagnostic criteria or age 18, and evidence of substantial limitations.

Important:

  • An individual must first apply to see if they are eligible (family member may apply for the individual).
  • Once eligible, the individual or family must apply for specific services.

Detailed information on the application process and on specific programs (“waivers”) can be found on the Informing Families website.

Lifespan Respite WA: offers a voucher (small grant) for unpaid family caregivers who support a family member, friend, or neighbor who needs assistance with daily living activities. The voucher is used to pay for services or programs that allow the caregiver to have respite, or short breaks from caregiving tasks. Lifespan Respite vouchers are for temporary short-term respite. 

Eligibility: the caregiver

  • Is not paid to care for their family member, friend, or neighbor;  
  • Provide 40 or more hours per week of care or support for someone with a special need or condition (the person can be any age), and the 40 or more hours must include supervision of the person receiving care;
  • Live in Washington State; 
  • Not be able to afford respite care on their own;
  • The caregiver or the person they care for are not enrolled in any program that provides respite services, unless they are on a wait list and not scheduled to receive services within 30 days of the voucher application.

Read more about Lifespan Respite WA and apply online.

Department of Children Youth and Families (DCYF):

Foster parents provide temporary homes for children whose parents are unable to care for them. DCYF and the family court system authorize placement of a child or youth in foster care when it is necessary for a child’s safety and well-being. More than half of children and youth using foster care in WA State are cared for by a kinship caregiver—a grandparent, other relative, unrelated close friend or “chosen family”. Federally recognized Tribes in WA decide who is a relative of a child who needs foster care.

Three types of respite are available through DCYF for Licensed Foster Parents, Unlicensed Relative Caregivers and “Other Suitable Persons”  (definitions at DCYF): Retention Respite (monthly breaks, emergent situations); Exchange Respite (arranged between licensed caregivers, approved by case workers and is not financially reimbursed); and Child-Specific Respite for relief from caregiving responsibilities linked to medical, behavioral or special needs of an individual child or youth.

Informal kin caregivers who do not have any contact with the foster care system may receive access to some benefits through the Kinship Program at WA’s Department of Social and Health Services. They may also be eligible if they or their kin child qualifies under any of the other programs listed under “All Ages”.

The WA Cares Fund is a public long-term care insurance program. All working Washingtonians contribute a small percentage of their income into the fund. Benefits can fund respite care and many in-home services. If a family caregiver retired prior to the program start in 2023, or if they left to care for their loved one, they may not be eligible for this program. If they did work from the start of the program but need respite services sooner than later, they may not have accumulated much in the fund. The maximum amount for benefits is $36,500, which will be adjusted for inflation.

Veterans and Military Family Caregivers

Active duty family members’ loved ones may be eligible for respite under Tricare Echo, a benefit under the military healthcare plans.

Exceptional Family Member Program: Provides all four military branches with care and respite support for families with a member who has a special need or disability. When military respite is not available, military families should know they are also eligible to apply for civilian respite services while living in Washington State.

Coast Guard Special Needs Program: provides Coast Guard family members who have special needs or a disability with care and support. Coast Guard families may also apply to civilian sources of respite care in Washington State.

Financial help paying for respite care may be available through Coast Guard Mutual Assistance. https://mycgma.org/

Veterans Affairs offers the Program of Comprehensive Assistance for Family Caregivers (PCAFC) which offers respite services.

Do you have questions about respite?

Please contact Get Support and select “respite (Lifespan)” as a reason for contacting PAVE, or call Lifespan Respite WA at 253-442-3214.

Parent to Parent (P2P) Connects Caregivers Statewide for Support

Posted on by Nicol Walsh

Family caregivers for children with disabilities and special healthcare needs may feel isolated or uncertain about where to seek help for their children and themselves. A place for support is Parent to Parent (P2P), a network that connects families to trained parent volunteers who have experienced a similar journey with their own children. In addition to resources and information, parents share personal support and encouragement.

A Brief Overview

Full Article

Families new to the disability world can find preliminary information and request help right away by filling out a short form on a website page designed just for them, hosted by The Arc of Washington: Getting Started/Contact Us…Welcome to our World.

The first P2P program started in Nebraska in 1971. Programs started in Washington State in 1980. A national P2P network was established in 2003 to provide technical support to the statewide networks, with a goal to reach all 50 states. P2P USA provides an historical timeline.

Washington has a network of P2P programs that serve every corner of the state. The Arc provides support to the regional programs and links them to national P2P resources. Families can go to arcwa.org to find a list of P2P coordinators, organized by region and listed under the counties served.

¿Hablas español? Para más información y hacer referidos, llama a su condado abajo: Coordinadores de Enlance Hispano.

Families can request a parent match 

When reaching out to the local P2P network, families can request a “parent match.” P2P leaders will locate a helping parent volunteer who has a similar lived experience and help the families get connected. From there, a supportive relationship can develop, where empathy, hope, and strength are shared.

Helping Parents cannot provide all answers, but they share insight, solidarity, and role modeling. They also share the joy and pride they’ve experienced while watching their child grow and achieve. A phrase commonly shared is: “I know, and I understand.”

In keeping with evidence-based practices promoted by national and state P2P organizations, the helping parent volunteers are training following a specific process and all personal information is kept confidential.

P2P services are free and include:

  • Emotional support for family caregivers of children with special needs
  • Referrals for community resources
  • Information sharing about disabilities and medical conditions
  • Family matching with trained helping parents
  • Social and recreational events
  • Training for parents who would like to become helping parent volunteers
  • Disability awareness and community outreach

Someone to listen and understand

Washington’s statewide P2P is funded by The Arc of Washington State, the Developmental Disabilities Administration (DDA), and the Department of Health/Children with Special Health Care Needs. Individual county programs receive funding from host agencies, county DDA offices, the United Way, local grants, private donations, and more.

The Council for Exceptional Children published a research paper about P2P in 1999. Respondents to a national survey reported the following benefits from participating in P2P:

  • Someone to listen and understand (66 percent)
  • Disability information (63 percent)
  • Care for my child (58 percent
  • Ways to find services (54 percent)

Statewide, various agencies and family-led organizations host local P2P programs. An interactive map of Washington State provides an easy way to locate information in English and Spanish about a P2P program in your area.

Another way to begin is to contact the statewide P2P coordinator, Tracie Hoppis, by sending an email to: parent2parentwa@arcwa.org.

Apple Health for Kids: Medicaid and Children’s Health Insurance Program (CHiP) in Washington State

Posted on by Nicol Walsh

Overview

  • In Washington State, Medicaid, which includes the Children’s Health Insurance Program (CHiP) is called Apple Health. Medicaid and CHIP are medical insurance programs run by the state and funded by the federal government and the state.
  • Children can get free or low-cost health insurance from birth to age 19.
  • A child’s eligibility is based on living in Washington State, and the family level of income. Immigration status does not apply to Apple Health for Kids, and family information will not be shared with immigration officials.
  • There are links in this article to information on Apple Health insurance coverage for parents and caretakers, pregnant individuals, young adults, and children in foster care or who have been in foster care.

Where to apply or find more information about Apple Health for Kids:

Full Article

In Washington State, Medicaid, which includes the Children’s Health Insurance Program (CHiP) is called Apple Health. Medicaid and CHIP are medical insurance programs run by the state and funded by the federal government and the state.

The state agency that runs Apple Health programs is the Health Care Authority. This is the official website to get information about Apple Health programs. For some programs, such as Home and Community-Based Services Waivers (HCBS waivers) the Health Care Authority partners with the Department of Social and Health Services (DSHS). Find out more about HCBS waivers and similar programs at Informing Families.

Apple Health for Kids is free or low-cost health insurance for children from birth to age 19.

It covers the costs of medical, dental, vision (eye) care, hearing care, and behavioral (mental) health.

Medicaid programs, including CHiP, make sure that children get Early and Periodic Screening, Diagnostic, and Treatment services.

These services mean children get regular physical exams, are screened (checked) for any problems with physical and mental health, developmental delays, dental health, hearing, vision, and other tests to find any problems and treat them.

Are complex medical needs covered under Apple Health for Kids?

Yes, the Medically Intensive Children’s Program (MICP) is a Medicaid program for children who need a registered nurse to provide support.  Visit the MICP page at WA State’s Health Care Authority.

Who can get Apple Health for Kids?

  • The child must live in Washington State.
  • The family income must be below a certain amount. Based on the family income level, a child may qualify for either the free Apple Health for Kids (Medicaid), or for Apple Health for Kids with premiums (CHiP).

Important! Children and pregnant individuals may qualify for WA Apple Health coverage regardless of their immigration status.

Information from WashingtonLawHelp.org says:

“All children up to age 19 who have low income are eligible for free medical coverage (“Washington Apple Health”) in Washington State. There are no immigration status requirements for this coverage. Children from families with moderate income can also get coverage. They may have to pay a small monthly premium.

Your children may also be eligible for other programs, including Head Start and other education programs, school meals, and child nutrition programs

It’s generally very safe to apply.  State and federal laws protect the privacy of the information you put on your application. Your information should not be shared with immigration officials.

If you prefer, you can choose to apply for benefits for other family members, such as your children, and not for yourself. You won’t have to give information about your own immigration status, but you may have to give proof of your family’s income.”

Costs of Apple Health for Kids:

People on Apple Health (adults and children) do not pay cost-sharing, co-payments, or deductibles for any service.

There are three premium price levels for Apple Health for Kids:

  • Free (no monthly premiums)
  • Low monthly premium (payment to get the Apple Health Insurance plan)
  • Slightly higher monthly premium

Every year in April, WA State may adjust the amount of income a family can make to qualify for Apple Health for Kids. The premium amounts for Apple Health for Kids with premiums may also change. These changes take inflation and Apple Health program costs into account.

To check if  your family income meets the limits for Apple Health for Kids, go to the WA State Health Care Authority page for Children.

Exception: children of public and school employees who have access to, or are enrolled in health insurance coverage under PEBB or SEBB programs may be eligible for Apple Health for Kids with premiums.

Important to Know:

Apple Health for Kids includes “continuous coverage”. This means a child or youth can stay on Apple Health for Kids even if their family’s income goes above the Apple Health income limits during the continuous coverage period.

This rule applies to free Apple Health for Kids (Medicaid) and Apple Health for Kids with premiums (CHiP). The rule applies to both “with premium” plans.

  • For free Apple Health for Kids: Children birth to age 6 have continuous coverage from when they are enrolled until their 6th birthday.
  • For Apple Health for Kids with premiums, children from birth to age 6 have continuous coverage for 12 months at a time.
  • From age 6 to age 19, all three Apple Health for Kids programs have continuous coverage for 12 months at a time.  

If a child loses their coverage and needs to re-enroll, learn more on the HCA website or by emailing HCA at AskMAGI@hca.wa.gov.

Protections for children’s health insurance: New federal rules for Medicaid and CHiP

The new rules start as of June 1, 2024, but states have some time to make changes to their programs. WA State already follows these rules, but the new rules prevent WA State from doing any of these things in the future.

States will not be allowed to:

  • Require a waiting period before a child can be covered by Medicaid or CHiP health insurance
  • Stop a child’s Medicaid or CHiP health insurance if the family misses premium payments, during the continuous coverage period
  • Make a family pay back the unpaid premiums before a child can re-enroll after their continuous coverage period runs out, or charge an enrollment fee
  • States can’t put a dollar limit on benefits for CHiP. (Medicaid doesn’t allow dollar amount limits). Benefits can be limited in terms of what services are covered, or how often a service can be used. For instance, a state could decide CHiP will only cover a total of 12 visits for physical therapy in one benefit year

Health Coverage for Teens and Young Adults

Teens under age 18 who want or need to get health care coverage without their parents may be eligible for Apple Health under one or more of these conditions:

  • Live separately from parents or guardians and are not claimed by them as a tax dependent
  • Are pregnant
  • Need birth control or STI (sexually transmitted infection) care

To apply, follow these instructions on the Fact Sheet for Apple Health Teen Application Process.

Young adults aged 19 and up may be eligible for Apple Health if they meet income guidelines or have been in foster care. Apply online at Washington Healthplanfinder.

Other WA State Medicaid programs that may help people who care for children, or who are pregnant:

Parents and Caretakers

Pregnant Individuals

Foster Care

Resources:

The Family to Family Health Information Center (F2FHIC)

Helpline at PAVE

Informing Families

Medicaid Basics (article from PAVE)

WashingtonLawHelp.org

Washington State Health Care Authority

Washington State Healthplanfinder

WithinReach

Changes to improve monitoring for quality and improve oversight of HCBS Waiver Programs

New rules

The new rules will apply to § 1915(c) HCBS waivers and §§ 1915(i) state plan services, (j) personal assistance services, and (k) Community First Choice. The new rules will also apply under § 1115 demonstration projects unless specifically waived, and under FFS and managed care delivery systems.

  • Update functional assessments and person-centered plans at least once every 12 months;
  • Establish grievance procedures for Medicaid beneficiaries receiving certain HCBS services in FFS (there are already grievance procedures applicable to managed care);
  • Establish an incident management system to identify, investigate, and resolve critical incidents, including reports of abuse, neglect, and financial exploitation;
  • Provide assurances that payment rates are adequate to ensure a sufficient direct care workforce;
  • Collect and report data to monitor access (e.g., waiting lists, average amount of time between approval for and delivery of HCBS services, percent of authorized hours provided); and
  • Report on core measures in the HCBS Quality Measure Set.

Traumatic Brain Injury in Youth

Posted on by Nicol Walsh

A Brief Overview

  • A traumatic brain injury (TBI) is an injury that affects how the brain works.
  • Approximately 1.7 million people receive traumatic brain injuries every year. Of children 0-19 years old, TBI results in 631,146 trips to the emergency room annually, 35,994 hospitalizations, and nearly 6,169 deaths.
  • Children have the highest rate of emergency department visits for traumatic brain (TBI) injury of all age groups. TBI affects children differently than adults.
  • Although TBI is quite common, many medical and education professionals may not realize that some difficulties can be caused by a childhood TBI. Often, students with TBI are thought to have a learning disability, emotional disturbance, or an intellectual disability. As a result, they may not receive the type of educational help and support really needed.
  • Students with TBI who are not eligible for special education might be eligible for a Section 504 plan.
  • TBI is a category of eligibility for special education under the Individuals with Disabilities Education Act (IDEA) and the Washington State Administrative Code (WAC)
  • Washington law requires evaluation referrals in writing. The state provides a form for referrals, downloadable from a website page titled, Making a Referral for Special Education. The person making the referral can use the form or any other format for their written request.
  • PAVE provides a Sample Letter to Request Evaluation.

Full Article

A traumatic brain injury (TBI) is an injury that affects how the brain works. TBI can affect people of all ages and backgrounds. The exact definition of TBI, according to special education law, is referenced later. This injury can change how the person thinks, behaves, and moves. A traumatic brain injury can also change how a student learns and behaves in school. The term TBI is used for head injuries that can cause changes in one or more areas, such as:

  • thinking and reasoning,
  • understanding words,
  • remembering things,
  • paying attention,
  • solving problems,
  • thinking abstractly,
  • talking,
  • behaving,
  • walking and other physical activities,
  • seeing and/or hearing, and
  • learning.

The term TBI is not used for a person who is born with a brain injury or for brain injuries that happen during birth.

How is TBI Defined?

The definition of TBI below comes from the Individuals with Disabilities Education Act (IDEA). The IDEA is the federal law that guides how schools provide special education and related services to children and youth with disabilities.

IDEA’s Definition of TBI

The Individuals with Disabilities Education Act (IDEA) defines traumatic brain injury as

“…an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” [34 Code of Federal Regulations §300.8(c)(12)]

Washington State’s Definition of TBI

“Traumatic brain injury means an acquired injury to the brain caused by an external physical force, resulting in total or partial functional disability or psychosocial impairment, or both, that adversely affects a student’s educational performance. Traumatic brain injury applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem solving; sensory, perceptual, and motor abilities; psychosocial behavior; physical functions; information processing; and speech. Traumatic brain injury does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.” (WAC 392-172A-01035)

What Are the Signs of Traumatic Brain Injury?

The signs of brain injury can be quite different depending on where the brain is injured and how severely. Students with TBI may have one or more difficulties, including:

Physical disabilities: Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and feel tired a lot. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten (this is called spasticity). They may also have seizures. Their balance and walking may also be affected. They may be partly or completely paralyzed on one side of the body, or both sides.

Difficulties with thinking: Because the brain has been injured, it is common that the person’s ability to use the brain changes. For example, students with TBI may have trouble with short-term memory (being able to remember something from one minute to the next, like what the teacher just said). They may also have trouble with their long-term memory (being able to remember information from a while ago, like facts learned last month). People with TBI may have trouble concentrating and only be able to focus their attention for a brief time. They may think slowly. They may have trouble talking and listening to others. They may also have difficulty with reading and writing, planning, understanding the order in which events happen (called sequencing), and judgment.

Social, behavioral, or emotional problems: These difficulties may include sudden changes in mood, anxiety, and depression. Students with TBI may have trouble relating to others. They may be restless and may laugh or cry a lot. They may not have much motivation or much control over their emotions.

A student with TBI may not have all the above difficulties. Brain injuries can range from mild to severe, and so can the changes that result from the injury. This means that it is hard to predict how an individual will recover from the injury. Early and ongoing help can make an enormous difference in how the student recovers. This help can include physical or occupational therapy, counseling, and special education.

It is also important to know that, as children and youth grow and develop, parents and teachers may notice new problems. This is because, as young people grow, they are expected to use their brain in new and different ways. The damage to the brain from the earlier injury can make it hard for them to learn new skills that come with getting older. Sometimes families and teachers may not even realize that the student’s difficulty comes from the earlier injury.

How to Access Support

If a student is having a tough time at school and has a known or suspected disability, the school evaluates to see if the student qualifies for special education. A student is protected in their right to be evaluated by the Child Find Mandate, which is part of the federal Individuals with Disabilities Education Act (IDEA). if they do have a disability and, because of the disability, need special services under IDEA. These services can include:

Early Supports for Infants and Toddlers (ESIT): A system of family centered services to support infants and toddlers with disabilities (before their 3rd birthday).

Special education and related services: Services available through the public school system for school-aged children and youth, including preschoolers (ages 3-21). It is important to remember that the IEP is intended to be flexible. It can be changed as the family, school, and the student learns more about what support and services are needed at school.

If the student is not eligible for special education, a Section 504 Plan may help. Under Section 504, students with disabilities can access the accommodations, aids, and services they need to access and benefit from education. It also protects students from discrimination based on disability.

When students with TBI return to school, their educational and emotional needs are often quite different than before the injury. Their disability has happened suddenly and traumatically. They can often remember how they were before the brain injury. This can bring on many emotional and social changes which may result in mental and/or behavioral health needs. The student’s family, friends, and teachers also recall what the student was like before the injury. These and other people in the student’s life may have trouble changing or adjusting their expectations of the student. Therefore, it is important to plan carefully for the return to school.

Tips for Families and Caregivers

  • Learn about TBI. The more you know, the more you can help yourself and your student.
  • Work with the medical team to understand your loved one’s injury and treatment plan. Ask questions. Share what you know or think. Make suggestions.
  • Keep track of your loved one’s treatment. A 3-ring binder or a box can help you store this history. As your youth recovers, you may meet with many doctors, nurses, and others. Write down what they say. Put any paperwork they give you in the notebook or place it in a box.
  • Plan for your student’s return to school after the injury. Contact the school. Ask the principal about an evaluation for special education or a Section 504 plan. You may also consider asking the medical team to share information with the school.
  • Talk to other families whose loved ones have TBI.
  • Stay connected with your student’s teacher. Tell the teacher about how your student is doing at home. Ask how your student is doing in school.
  • Sometimes students who do not qualify for the IEP will qualify for accommodations and other support through a Section 504 Plan. PAVE has an article about Section 504, which provides an individual with protections throughout the lifespan.
  • Protections against bullying and discriminatory discipline are aspects of Section 504. Watch PAVE’s video, Behavioral Health and School: Key Information for Families.

Help from PAVE

PAVE’s Parent Training and Information (PTI) team provides 1:1 support and additional resources. Click Get Help or Call 1-800-5PARENT (572-7368) and select extension 115, English or Spanish available, to leave a dedicated message.

For information, help during a crisis, emotional support, and referrals:  

  • Suicide Prevention Lifeline (1-800-273-TALK): After July 16, 2022, call 988.
  • Text “HEAL” to 741741 to reach a trained Crisis Text Line counselor.
  • TeenLink (1-866-833-6546; 6pm-10pm PST)
  • Seattle Children’s Hospital has a referral helpline. Families can call 833-303-5437, Monday-Friday, 8-5, to connect with a referral specialist. The service is free for families statewide.

Further information on TBI:  

Family Support

  • PAVE’s Family-to-Family Health Information Center provides technical assistance to families navigating health systems related to disability. Click Get Help at wapave.org or call 800-572-7368 for individualized assistance. Family Voices of Washington provides further information and resources.
  • Department of Health and Human Services (DSHS) has a link to Washington TBI Support Groups.
  • Brain Injury Association of America works to create a better future through brain injury prevention, research, education, and advocacy.