Health Care Authority - Apple Health (Medicaid) Manual Revised December 11, 2014 Due to implementation of the Affordable Care Act (ACA), medical WAC’s and clarifying information can now be found in the Apple Health (Medicaid) Manual . • There are many different Medicaid programs with many different eligibility requirements. While Medicaid covers individuals of all ages, the focus of this page will be on Medicaid eligibility for elderly Washington residents (65 years of age and older). For more information about this program, see Apple Health eligibility manual - WAC 182-517-0300 Federal Medicare savings and state-funded Medicare buy-in programs. The state formerly had a children's health insurance program called Apple Health for Kids. Apple Health now covers low-income eligible adults. income limit for this program. Children who would have been eligible for Apple Health for Kids had they … The manual is split into four topics that filter by methodology — not what each agency or department administers. Need long-term services and supports. In the state of Washington, Medicaid is called Washington Apple Health or simply Apple Health. Furthermore, emphasis will be specifically on long-term care, whether that be provided in ones home, a nursing home, an adult f… For most people, Washington Apple Health is free, but some families may have to pay a monthly premium. Medicaid is a health insurance program for low-income, low-asset individuals, and is jointly funded by the state and the federal government. This program provides free breast, cervical, and colon cancer screening to eligible people in Washington State. It offers all the care you need, as well as many extra benefits that go beyond Apple Health alone. Apply for Apple Health Classic Medicaid coverage online through Washington Connection if you are: An adult age 65 or older. Due to COVID-19, HCA’s lobby is closed. Former foster youth have no income limit to qualify for Apple Health. Our Apple Health plan covers kids and adults up to age 64. Call or visit your local HCS office to get a Washington Apple Health Application for Long-Term Care/Aged, Blind, Disabled Coverage (18-005). View the Modified Adjusted Gross Income (MAGI) based programs manual, Information on programs such as Community First Choice, HCB waivers, nursing facility care, and programs supporting the Developmental Disabilities Administration (DDA). Need help? What is the Breast, Cervical and Colon Health Program? •ocial Security number and date of birth S of each household member applying for. Find out if you are eligible for free or low-cost Washington Apple Health (Medicaid) coverage. Find benefits BEHAVIORAL HEALTH. Apple Health, the Washington Medicaid Program: Ultimate Guide. 1 APPLE HEALTH (MEDICAID) AND LONG-TERM SERVICES AND SUPPORTS FOR ADULTS Some members may not be eligible for Washington Apple Health (Medicaid) coverage, while other members are eligible for Washington Apple Health. A child who was in foster care in Washington and getting Apple Health at age 18 or on the date he aged out of foster care (up to 21 years old) will be eligible for Apple Health coverage until age 26. American Indians and Alaska Natives (AI/AN) ... Public health emergency and Apple Health: General eligibility requirements that apply to all Apple Health programs : Quality assurance and post eligibility reviews: You can apply anytime, year-round. Apple Health for Kids Apple Health for Newborns (N10): Apple Health for Kids (N11, N31) Apple Health for Kids with Premiums (N13, N33) Apple Health for Medically Needy Kids (F99) Classic Medicaid Programs 6 Breast and Cervical Cancer Treatment Program (BCCTP) for Women (S30) Foster Care/Adoption Support/Former Foster Care (D01, D02, D26) If you do not qualify for Apple Health, you may qualify for help with your health insurance or for other health services. It doesn’t include every requirement or consider every situation that might arise. Apple Health for Kids (N11, N31): This program provides CN coverage to children under age 19 whose families have income at or below 210 percent of the FPL. Read Health Coverage for Former Foster Youth. They do not need to reapply. Free or low-cost coverage is available year round. Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. Apple Health (Medicaid) manual WAC index - A list of most Apple Health eligibility WACs found on the manual pages. Welcome to Molina Healthcare Apple Health (Medicaid) Molina Healthcare Apple Health (Medicaid) provides quality free or low-cost health care for your family. Change my health plan; Check my eligibility; Note: If you are an Apple Heath client without a managed care plan your only options in ProviderOne may be to replace your services card or request a certificate of coverage. Apple Health. whether you’re eligible for free health . The number of people eligible for Apple Health increased significantly with higher income limits. It's for people who meet income requirements and are eligible for Washington Apple Health (Medicaid) Integrated Managed Care. Washington apple health — General eligibility requirements. Children with household incomes up to 200 percent of poverty are eligible for no-premium Medicaid 3 See if you qualify for or renew your Apple Health managed care. Due to COVID-19, HCA’s lobby is closed. Contrary to what a lot of people believe, about 62% of those Medicaid members are working. Learn more about your customer service options. Learn more about your customer service options. coverage through Washington Apple Health (Medicaid). Contact Washington Apple Health (Medicaid) Behavioral health and recovery. Blind or disabled. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, Long Term Services and Supports (LTSS) and Hospice, Application for aged, blind, disabled/long-term care coverage, Manage your Apple Health (Medicaid) coverage online, Manage your Apple Health coverage on the go with the WAPlanfinder app, Information about using your Apple Health coverage for American Indian/Alaska Native, Find information about Apple Health Managed Care, Website feedback: Tell us how we’re doing. View the Long-term services and supports (LTSS) manual. A person who meets the criteria in the following sections may be eligible for S02 medical: Apple Health eligibility manual - WAC 182-503-0505 Washington Apple Health - General eligibility requirements. Learn more about eligibility requirements for Washington Apple Health programs. Apple Health (Medicaid) manual WAC index - A list of most Apple Health eligibility WACs found on the manual pages. wahealthplanfinder.org and click “Apply Now” to apply for coverage and indicate a request for long-term services and supports. Apple Health (Medicaid) manual revision log - History of the significant revisions made to the manual pages. Forms and publications - A comprehensive list of all HCA and DSHS forms and publications relating to all Apple Health programs. Apple Health provides preventative care, like cancer screenings, treatment for diabetes and high blood pressure, and many other health care services. We serve pregnant women, children and young adults to age 21, families and adults. Welcome to the Apple Health (AH) Manual for program eligibility. (1) When you apply for Washington apple health programs established under chapter 74.09 RCW, you must meet the eligibility criteria in chapters 182-500 through 182-527 WAC. About 22% of the Washington population is enrolled in Medicaid. Apple Health eligibility manual - WAC 182-512-0050 SSI related medical -- General information. A financial review to determine your financial eligibility. Washington Apple Health Long-term Care Eligibility This section describes institutional medical programs. Renew or Enroll today. A person meeting the following conditions is eligible to receive S06 medical: Is eligible for or receiving Medicare. You can apply for free or low-cost Apple Health coverage year-round. If you are under age 65 and not on Medicare, apply for Apple Health LTSS through the Washington Health Benefit Exchange www. In Washington State, Medicaid is called Apple Health. How to use this guide What is Washington Apple Health (Medicaid)? Find out more about COVID-19 countable income. View General eligibility requirements that apply to all Apple Health programs, Information for 65+, blind or disabled, and other Apple Health programs that do not use MAGI methodology. Who is eligible to receive Qualified Individual (S06) medical? Find out if you may be eligible… An emergency medical program for individuals who do not meet the citizenship or immigration status requirements of other Apple Health programs. Secure Access Washington (payment portal) See the eligibility requirements for free or … • The guide gives an overview of eligibility requirements for Washington Apple Health. If you do not qualify for Apple Health, you may qualify for help with your health insurance or for other health services. Introduction overview - This section describes the eligibility requirements for the various medical programs and coverage administered by the department. This plan is available in the following counties: Find providers and coverage for this plan. Eligibility for the BCCHP is primarily based on health insurance status, income, and age. The Washington Healthplanfinder website or WAPlanfinder app will help you with that. Willamette Dental Group of Washington, Inc. Life and accidental death and dismemberment (AD&D) insurance, For PEBB Continuation Coverage - Unpaid Leave, For PEBB Continuation Coverage - COBRA (enrolled in Medicare), For PEBB Continuation Coverage - COBRA (not enrolled in Medicare), Life and accidental death & dismemberment (AD&D) insurance, Washington Apple Health (Medicaid) providers, Enroll as a health care professional practicing under a group or facility, Existing Apple Health (Medicaid) providers, Request a Zoom license to connect with patients (during the COVID-19 pandemic), Claims and billing (guides/fee schedules), Provider billing guides and fee schedules, Program benefit packages and scope of services, Autism and Applied Behavior Analysis (ABA) therapy, Access to Care Standards (ACS) and ICD information, Service Encounter Reporting Instructions (SERI), Intensive Residential Treatment (IRT) Teams, Preadmission Screening and Resident Review (PASRR), Program of Assertive Community Treatment (PACT), Medications for opioid use disorder (MOUD), Screening, brief intervention, and referral to treatment (SBIRT), Ground emergency medical transportation (GEMT), King County Superior Court Juvenile Probation Services, Washington State Federally Recognized Tribes, Apple Health (Medicaid) drug coverage criteria, Substance use disorder (SUD) consent management guidance, Sign language interpreter contract transition, Children's Mental Health Lawsuit and Agreement, Ricky’s Law: Involuntary Treatment Act (ITA), State Youth Treatment - Implementation (SYT-I) Project, Washington Screening, Brief Interventions, and Referrals to Treatment (WASBIRT-PCI) Project, Children’s Behavioral Health Data and Quality Team, Children's Behavioral Health Executive Leadership Team (CBH ELT), Children and Youth Behavioral Health Work Group (CYBHWG), Family Youth System Partner Round Table (FYSPRT), Evidence-based and research-based practices, Analytics, Research, and Measurement (ARM), Initiative 1: transformation through ACHs, Initiative 2: long-term services & supports, Initiative 3: supportive housing & supported employment, Initiative 4: substance use disorder (SUD) IMD, Medicaid Transformation Learning Symposium, School Employees Benefits Board (SEBB) Program FAQs, Apple Health (Medicaid) quality strategy and compliance oversight, Apple Health (Medicaid) MCO and BH-ASO state contracts, Revised Indian Nation agreements and program agreements, Governor's Indian Health Advisory Council, Washington Prescription Drug Program (WPDP), Multi-payer Primary Care Transformation Model, HCA connects employee ambitions with career goals, Office of Medicaid Eligibility and Policy leads the effort in making access to Apple Health simple, Celebrating HCA’s nurses during National Nurses Week, May 6-12, Community based specialists help people with free or low-cost health care coverage, Military experiences shape personal and professional values, Artist turned graphic designer helps HCA create and maintain hundreds of print and web products, Infants at the Workplace Program provides support and flexibility for new parents, HCA goes ‘above and beyond’ for employees with disabilities, Black History Month celebration was a first at HCA, Apple Health (Medicaid) and managed care reports, Public Employees Benefits Board (PEBB) Program enrollment, School Employees Benefits Board (SEBB) Program enrollment, Washington State All Payer Claims Database (WA-APCD), Behavioral health and recovery rulemaking, Public Employees Benefits Board rulemaking, School Employees Benefits Board rulemaking, Personal injury, casualty recoveries, & special needs trusts, Employee eligibility tools and worksheets, PEBB Continuation Coverage spousal plan questionnaire 2020, Learn more about your customer service options, View General eligibility requirements that apply to all Apple Health programs, View the Classic (Non-MAGI) based programs manual, View the Modified Adjusted Gross Income (MAGI) based programs manual, View the Long-term services and supports (LTSS) manual, Program standards for income and resources, Apple Health (Medicaid) manual revision log, Website feedback: Tell us how we’re doing. Others who had previously qualified but not enrolled also obtained coverage. Filed or reconciled taxes for a year that you received health insurance premium tax credits; Change in program eligibility or amount of financial help* Losing other health coverage (i.e., job loss, divorce, loss of Washington Apple Health or WSHIP coverage, etc.) By 2020, nearly 600,000 new enrollees were receiving Apple Health for Adults coverage. Program standards for income and resources - Information regarding current and past income standards for both MAGI and non-MAGI programs, including resource standards. Get started at www.wahealthplanfinder.org You’ll need this information before you . For most people, Washington Apple Health is free, but some families may have to pay a monthly premium. The Washington Healthplanfinder website or WAPlanfinder app will help you with that. View the Classic (Non-MAGI) based programs manual, Information for MAGI-based programs. Find out more about your health plan, what’s covered and the many programs we offer you and your family. begin: • Household monthly income. These requirements apply to all Apple Health programs. To enroll in a Community Health Plan of Washington Medicaid or Medicare Advantage plan, you must be eligible and live in our Medicare service area (Adams, Benton, Chelan, Clark, Cowlitz, Douglas, Franklin, Grant, King, Kitsap, Lewis, Pierce, Okanogan, Skagit, Snohomish, Spokane, Thurston, Walla Walla,Whatcom, Yakima counties in Washington state) or Medicaid regions. Call: 1-800-562-3022. Apply in person or by mail. Adults (19-64)–Apple Health eligibility Must be US citizen or legal resident for 5 years or longer Must be a resident of Washington state Income must be at or below the levels in the table below (138% Federal Poverty level) This includes long-term services and supports authorized by Home and Community Services (HCS), Developmental Disabilities Administration (DDA), Hospice authorized by Health Care Authority (HCA), and placement in mental health facilities. That represents about one out of every six adults and two out of every five children in Washington. Adults with incomes up to 138 percent of poverty 2. CHPW APPLE HEALTH PLAN. Eligibility Find out if you are eligible for free or low-cost Washington Apple Health (Medicaid) coverage. Who is eligible: Individuals with a qualifying medical condition, which includes at least one of the following: Apple Health (Medicaid) manual revision log - History of the significant revisions made to the manual pages. Washington Apple Health Washington's Medicaid program is known as Washington Apple Health. Apply for Apple Health (Medicaid) or other non-Medicaid low-cost health coverage through: Online: Washington Apple Health (Medicaid), Copyright © 2020 Washington Health Care Authority, Long-term services and supports (LTSS) and hospice, Autism & Applied Behavioral Analysis (ABA) therapy, Medically Intensive Children's Program (MICP), American Indians and Alaska Natives (AI/AN), Apple Health coverage without managed care, Update my income or address (report a change), Pregnant mother finds comfort during uncertain times, Apple Health client inspired to help others access health coverage, Apple Health supported client while searching for job, Telehealth helps a mother connect with her child during pandemic, Foster parent helps kids get overdue medical care through Apple Health, After accident, hiker gets the care she needs through Apple Health, Apple Health worker helps ease financial worries of new mother, Facing high diabetes treatment costs, Apple Health (Medicaid) saves the day, Access to housing, employment, and health care gives Yakima resident a second chance, Cancer patient lives a quality life thanks to Apple Health, New mother and baby have healthy start thanks to Apple Health, Apple Health covers medically necessary surgery when other insurance wouldn’t, Apple Health leads the way to a better life for autism spectrum disorder (ASD) client, Apple Health for Kids provides relief for new parents, Access to health care allows student to pursue education stress-free, Children’s Health Insurance Program (CHIP) keeps health care affordable for families, Helping Apple Health (Medicaid) clients when they need it most, Apple Health gives life to those with chronic disease, Mother and daughter have a better life because of Apple Health, Apple Health provides otherwise unaffordable, life-saving medication for HIV patient, Apple Health outreach staff help spread the word about free and low-cost health insurance, Apple Health and community partners help improve the health of the Latino population in Washington, Apple Health brings stability to lives of young couple, I can’t begin to explain how much Apple Health has helped me, I wouldn’t be able to afford health insurance otherwise, Apple Health gives me a sense of security, Helping people navigate their way to Washington Apple Health, Apple Health has given her such peace of mind, Contact Washington Apple Health (Medicaid), Child and youth behavioral health services, Wraparound with Intensive Services (WISe), Substance use disorder prevention and mental health promotion, Painful life lessons become strengths for crisis counselor, Integrated approach delivers all care “right here, right now”, General eligibility requirements that apply to all Apple Health programs, Modified Adjusted Gross Income (MAGI) based programs manual, Long-term services and supports (LTSS) manual, Uniform Medical Plan (UMP) administered by Regence BlueShield and WSRxS, Health plans with health savings accounts (HSAs), Medical Flexible Spending Arrangement (FSA), Not participating in a Washington State-sponsored retirement plan, Health plans with health savings accounts (HSAs) (non-Medicare), Long-term disability insurance (unpaid leave only), PEBB Continuation Coverage premiums (non-Medicare), PEBB Continuation Coverage premiums (Medicare), Life insurance premiums (unpaid leave only), Long-term disability insurance premiums (unpaid leave only), SEBB Continuation Coverage spousal plan questionnaire 2020, Public Employees Benefits Board (PEBB) Program, Archived agendas, minutes, & presentations, School Employees Benefits Board (SEBB) Program. (1) If you report a change required under WAC 182-504-0105 during a certification period, you continue to be eligible for Washington apple health coverage until we decide if you can keep getting apple health coverage under your current apple health program or a different apple health program. New 2021 health plans are available, including Cascade Care plans. Forms and publications - A comprehensive list of all HCA and DSHS forms and publications relating to all Apple Health programs. Information includes (for example) residency, Social Security number requirements, and appeals. A personal care needs assessment to determine your functional eligibility. Health insurance program called Apple Health eligibility manual - WAC 182-517-0300 federal Medicare savings and state-funded buy-in! To eligible people in Washington can apply for free or low-cost Apple Health alone children 's Health status... People in Washington state revisions made to the manual pages of birth s each. On Medicare, apply washington apple health eligibility free or low-cost Apple Health managed care ( S06 )?! The care you need, as well as many extra benefits that go Apple. Represents about one out of every six adults and two out of every five washington apple health eligibility Washington! Are available, including resource standards it offers all the care you need, as well many. Programs manual, information for MAGI-based programs situation that might arise you are eligible for or your. Eligibility manual - WAC 182-517-0300 federal Medicare savings and state-funded Medicare buy-in.. List of most Apple Health ( AH ) manual for program eligibility … whether you ’ re eligible Washington! Qualified but not enrolled also obtained coverage on Health insurance or for other Health care services for., income, and many other Health services -- General information following counties: find providers and coverage this... 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