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)
| Service | Single 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):
| Service | 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 | $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):
| Service | 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 | $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:
- For those aged 19 through 64.
- For U.S. citizens or those who meet Medicaid immigration requirements. NEW: Only the following groups are eligible:
- U.S. citizens and nationals
- Lawful permanent residents who have met or are exempt from the 5-year bar
- Compact of Free Association (COFA) islanders
- Cuban-Haitian entrants
- NEW: Work Requirement – To remain eligible, people enrolled in Apple Health for Adults will be required to work, train, or do community engagement 80 hours per month.
- For those who are not entitled to Medicare.
- Have annual household income at or below the Medicaid standard:
Eligibility for Apple Health for Adults:
| Service | Single 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:
- Review adult and/or child income and other eligibility requirements.
- View what services are provided through Apple Health to see if it 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, 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.
- 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.


