Whether an individual is on Medicaid, Medicare, or private health insurance, eligibility, costs, and covered services may change.
Washington’s Medicaid option, Apple Health, has different financial requirements for adults than it does for minors. The type of Medicaid a youth has before age 18 may change depending on the source of their income or benefits when they turn 18.
If the disability is significant, a student or young person may be on classic Medicaid. When they turn 18, they must contact the managed care organization (MCO) that is their current healthcare provider (Molina, Community Healthcare, Well Point, etc.) and:
- Confirm who their current healthcare provider is
- Confirm their own current address
They must do this every 12 months.
If the youth is not
- on Supplemental Security Income (SSI),
- receiving Developmental Disability (DDA/DDCS) services,
- or receiving state benefits for the blind such as Aging, Blind, or Disabled (ABD) Cash Assistance or State Supplementary Payment (SSP),
then they may be on Medicaid through the healthcare exchange, the Washington Health Plan Finder.
At 18, Washington youth are required to apply for or renew Apple Health by going to the Health Plan Finder website. Even if an individual is not eligible for fully subsidized (paid) healthcare, the Health Plan Finder can reveal some low-priced options.
Young adults who are on their parents’ private insurance will be covered under their parents’ plan until they are 26, unless the young adult works and are covered through an employer-based plan. When they turn 26, if they are not working and are not covered by SSI/SSDI, DDA/DDCS services, or any other disability based supports, they will need to apply for their own health insurance. Again, the Health Plan Finder can help you find affordable options, including Apple Health.
For individuals under 65 who are receiving Medicare due to a disability, insurance should not change due to the transition to adulthood. It is important to know which doctors can treat an individual’s conditions and whether an insurance plan includes those doctors. To find out, call the MCO/health provider’s helpline or view their website to find out whether those doctors are included in their insurance plan. The doctor’s office will also give information on which plans they accept and which ones they don’t.