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:
- To apply for Apple Health for Kids, or other Medicaid programs, go to Washington Healthplanfinder.
- Visit WA State’s Health Care Authority page about Children
- For information on the phone, call the Apple Health hotline at WithinReach: 206-204-3503 (weekdays).
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.”
- Check eligibility requirements for children
- Check eligibility requirements for pregnant individuals
- If not eligible, check limited coverage for noncitizens in WA State
- Check possible eligibility based on immigration status on this Fact Sheet
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:
Resources:
The Family to Family Health Information Center (F2FHIC)
Medicaid Basics (article from PAVE)
Washington State Health Care Authority
Washington State Healthplanfinder
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.