Washington and the ACA’s Medicaid expansion

Total Medicaid enrollment and uninsured rate are dramatically up in 2020

Key takeaways

Medicaid 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 percent 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.

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.

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 percent of the federal poverty level (FPL)
  • Children with household incomes up to 210 percent of poverty
  • Pregnant women with incomes up to 193 percent of poverty.
  • Children are eligible for CHIP with household incomes up to 312 percent 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 percent 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 do I apply for Medicaid in Washington?

In Washington State, most Medicaid enrollment is managed through the state-run exchange, Washington Healthplanfinder. (Other options are available if you are applying for “classic” or “traditional” Medicaid, such as Medicaid ABD or Long-term Services and Support.) 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.

Washington Medicaid enrollment

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. That was an enrollment growth of 58 percent, the sixth-highest percentage increase in the nation. The national average growth in Medicaid/CHIP enrollment was 29 percent, although that includes the 19 states that had not expanded their Medicaid programs during that timeframe.

Total Medicaid enrollment in Washington was 1,728,400 — including 549,700 people covered by Medicaid expansion — as of June 2019. Medicaid.gov tracking as of June 2020 show Washington Medicaid and CHIP enrollment as 1,780,968.

Impact on uninsured rate

According to U.S. Census data, the uninsured rate in Washington was 14 percent in 2013, and had fallen to 6 percent by 2016 — a drop of 57 percent. 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 percent 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 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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How to apply in WA

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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