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Washington and the ACA’s Medicaid expansion

Total Medicaid enrollment has increased significantly during the COVID pandemic

ACA’s Medicaid eligibility expansion in Washington

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Washington was one of five states that utilized a provision in the ACA that allowed for early expansion of Medicaid, prior to 2014.  As of 2011, Washington was using a waiver from CMS to allow for federal funding to cover adults with incomes up to 133% of poverty. Prior to 2011, Washington had covered these residents under the state-run Basic Health Plan, which was funded by the state. Switching to early Medicaid expansion and accepting federal funding for this population was an obvious choice for the state.

As a gubernatorial candidate in the fall of 2012, Democrat Jay Inslee expressed his support for Medicaid expansion, and he won the election that November. Soon after Inslee took office, he was encouraging lawmakers to move “quickly” to expand Medicaid in line with the ACA’s provisions.

Rather than take a formal vote on the issue however, Medicaid expansion was added as a line-item to the state budget (with bipartisan approval), and on June 30, 2013, Washington Governor Jay Inslee approved the budget for the upcoming fiscal year.

Eligible residents were able to begin submitting applications on October 1, 2013, with expanded Medicaid policies effective January 1, 2014.

Washington has accepted federal Medicaid expansion

  • 1,965,401 – Number of Washingtonians covered by Medicaid/CHIP as of May 2021
  • 847,825 – Increase in the number of Washingtonians covered by Medicaid/CHIP fall 2013 to May 2021
  • 54% – Reduction in the uninsured rate from 2010 to 2019
  • 76% – Increase in total Medicaid/CHIP enrollment in Washington since 2013

Who is eligible for Medicaid in Washington?

Apple Health (Medicaid in Washington) provides health insurance coverage for qualifying children, pregnant women, parents, seniors, and individuals with disabilities. See the Eligibility page on the Washington State Health Care Authority (HCA) website for details. Below is a summary of income limits for non-elderly adults and children.

  • Adults with incomes up to 138% of the federal poverty level (FPL)
  • Children with household incomes up to 210% of poverty
  • Pregnant women with incomes up to 193% of poverty.
  • Children are eligible for CHIP with household incomes up to 312% of poverty.

Apple Health for Kids is available to children even if they are undocumented immigrants. In that case, only state Medicaid funds are used to provide coverage, and families with income above 200% of the poverty level will have to pay higher premiums to cover a child who is undocumented. Pregnant undocumented immigrants are also eligible for state-funded Apple Health coverage.

How does Medicaid provide financial assistance to Medicare beneficiaries in Washington?

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Washington includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

How do I apply for Medicaid in Washington?

In Washington State, most Medicaid enrollment is managed through the state-run exchange, Washington Healthplanfinder. Unlike private health plans, Medicaid enrollment continues year-round; there is no specific time during the year that you must enroll.

One of the benefits of the streamlined exchange application process is that it’s dramatically expedited compared with the pre-2014 enrollment system.  The state notes that eligibility determination in the past took about 45 days, and they now take about 45 minutes.

But if you’re 65 or older or have Medicare, use this website to apply for Medicaid and several other social services benefits. You can also request an application by calling 1-877-501-2233. Visit a Department of Social and Health Services (DSHS) Community Services Office to apply for Medicaid for the aged, blind and disabled in person; visit a Home and Community Services Office to apply for long-term care benefits.

Washington Medicaid enrollment now exceeds 2 million people

As a result of Medicaid expansion, total enrollment in Washington Medicaid and CHIP grew by nearly 644,000 people between the fall of 2013 and November 2017. By mid-2021, total enrollment growth since 2013 had increased to nearly 850,000. That was a total enrollment growth of 76%, the sixth-highest percentage increase in the nation. The national average growth in Medicaid/CHIP enrollment was 44%, although that includes the dozen states that had not expanded their Medicaid programs during that timeframe.

Medicaid enrollment has increased during the COVID pandemic. This is due to the widespread job/income losses, as well as the Families First Coronavirus Response Act, which provides additional federal Medicaid funding to states on the condition that people not be disenrolled from Medicaid during the COVID public health emergency. So enrollment has trended upward since March 2020, and that will continue to be the case until the public health emergency period ends.

Total Medicaid enrollment in Washington was 1,965,401 as of May 2021, and had exceeded 2.1 million by October 2021.

Impact on uninsured rate

According to U.S. Census data, the uninsured rate in Washington was 14% in 2013, and had fallen to 6% by 2016 — a drop of 57%. Only eight states had a higher percentage point drop in uninsured rate during that time, and Washington’s drop was far higher than the 5.9 percentage point drop across the country as a whole. It’s clear that Medicaid expansion played a significant role in reducing the uninsured rate in the state.

However in 2020, the coronavirus triggered widespread job losses and subsequent losses of employer-sponsored health insurance. Washington State’s uninsured rate climbed to 12% as of May 2020.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Washington

Apply through or by calling 1-800-318-2596 (24 hours a day).

Eligibility: The aged, blind, and disabled.  Also, adults with incomes up to 138% of FPL; children with household incomes up to 200% of FPL are eligible for no-premium Medicaid; children with household incomes 200-300% of FPL eligible (with premium); pregnant women with incomes up to 185% of FPL.

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