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Medicaid eligibility and enrollment in Washington

Total Medicaid enrollment has increased significantly during the COVID pandemic, but disenrollments resume in May 2023


How is Washington handling Medicaid renewals after the pandemic?

During the COVID public health emergency, states have not been allowed to disenroll anyone from Medicaid, even if they no longer met the eligibility criteria (the only exceptions were if the person moved out of state, died, or requested a coverage termination). That continuous coverage rule was in place for three years, from March 2020 through March 2023. But starting as early as April 1, 2023, states can disenroll people who are no longer eligible for Medicaid.

 

States have a year to initiate eligibility redeterminations for everyone enrolled in Medicaid, in a process that’s being referred to as “unwinding” the pandemic-era continuous coverage rule. Washington plans to begin the unwinding in April, and has noted that their earliest Medicaid disenrollments could come at the end of April, but more likely at the end of May. This will continue for a year as the Apple Health program works through eligibility redeterminations for all enrollees, so some people will not get a renewal notice until late 2023 or early 2024.

People who are no longer eligible for Apple Health will need to secure new coverage, either through an employer, Medicare, or Washington Healthplanfinder (the state-run exchange/marketplace). A person’s circumstances will determine which of those coverage options is available to them, but all of them will offer a special enrollment period during which a person will be able to transition to the new coverage after losing Apple Health coverage.

People who are eligible for Cascade Care savings can enroll in that coverage at any time (Cascade Care savings is available through Washington Healthplanfinder for people who earn up to 250% of the poverty level and who select a standardized silver or gold plan). For people enrolling through Washington Healthplanfinder who aren’t eligible for Cascade Care savings, there will be a special enrollment period during which they can sign up for coverage. Employer-sponsored health plans must have at least a 60-day special enrollment period for people who lose Medicaid. And Medicare is offering a six-month enrollment period for people who are losing Medicaid and are now eligible for Medicare.

If a person loses Apple Health but was still eligible (perhaps because they didn’t respond to the renewal packet in time), they have 90 days to complete the renewal and their coverage will be reinstated as if it never ended.


ACA’s Medicaid eligibility expansion in Washington

Federal poverty level calculator

Washington was one of five states that utilized a provision in the ACA that allowed for early expansion of Medicaid, prior to 2014.  From 2011 through 2013, Washington used a waiver from CMS to allow for federal funding to cover adults with incomes up to 133% of poverty who were previously enrolled in three state-run programs (Basic Health, Medical Care Services, or Alcohol and Drug Addiction Treatment and Support Act). And the ACA’s full Medicaid expansion took effect in Washington as soon as it became available. Eligible residents were able to begin submitting applications on October 1, 2013, with expanded Medicaid policies effective January 1, 2014.

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.

Washington has also taken steps to ensure access to Medicaid for children and pregnant women, regardless of immigration status.

Washington Medicaid (Apple Health) enrollment grew by 92% between the fall of 2013 and the fall of 2022, and stood at nearly 2.3 million people by early 2023. That growth was driven largely by Medicaid expansion and the COVID pandemic, including the Families First Coronavirus Response Act rule that prevented states from disenrolling people from Medicaid during the pandemic. As described below, that provision ends in the spring of 2023, but it was in place for three years, resulting in record-high Medicaid enrollment nationwide.

Washington has accepted federal Medicaid expansion

  • 2,299,966 – Number of Washingtonians covered by Medicaid/CHIP (Apple Health) as of January 2023 (source)
  • 1,023,982 – Increase in the number of Washingtonians covered by Medicaid/CHIP fall 2013 to October 2022 (source)
  • 54% – Reduction in the uninsured rate from 2010 to 2019
  • 92% – Increase in total Medicaid/CHIP enrollment in Washington since 2013

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Who is eligible for Medicaid in Washington?

Apple Health (Washington’s Medicaid/CHIP) 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. (coverage for the mother continues for 12 months after the baby is born)
  • 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.

2.3 million enrolled in Apple Health as of early 2023

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 late 2022, total enrollment growth since 2013 had increased to more than one million people. And the total enrollment growth at that point was 92%, which was lower than only 10 other states. The national average growth in Medicaid/CHIP enrollment was 59% as of late 2022, although that included the dozen states that had not expanded their Medicaid programs during that timeframe.

Medicaid enrollment grew sharply when Medicaid was first expanded, in 2014 and 2015. But then it leveled out a bit in the years before the COVID pandemic. Starting in 2020, however, it grew sharply as a result of the pandemic. And the ban on disenrollments during the pandemic (described above) resulted in steady growth in Apple Health enrollment between 2020 and early 2023. Enrollment is expected to decline later in 2023 and in 2024, however, as the pandemic-era continuous coverage rule ends and states return to their normal eligibility redetermination processes.

Total Medicaid enrollment in Washington was just over 1.1 million in 2013, and had reached nearly 2.3 million by early 2023.

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.


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 healthinsurance.org. 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 HealthCare.gov 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.

Washington section

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