Washington Apple Health 2026: Who Qualifies, How to Apply

Apple Health pays your doctors, hospitals and pharmacies. It isn't cash or a grant, and there's no fee to apply. The full income chart is in our Washington Medicaid income limits guide.

Apple Health at a Glance (November 2026)

Washington runs Apple Health through 2 application systems: Washington Healthplanfinder for income-based (MAGI) coverage and Washington Connection for Classic Medicaid. According to the HCA pages Grantsights read on November 13, 2026:

Sources: HCA adults, kids, apply or renew and H.R. 1 changes pages, and WAC 182-503-0060, checked November 13, 2026.

Grantsights analysis of HCA's charts shows a $1,754 a month gap between what a Washington parent and child can earn and still qualify: for a family of three, the adult line is $3,142 while free Apple Health for Kids runs to $4,896, and kids' coverage with premiums runs to $7,218. A two-parent family over the adult line should still apply for the children.

Who Qualifies for Apple Health in 2026

HCA lists 5 tests for Apple Health for Adults: you're 19 through 64, you live in Washington, your income is at or under the standard, you're a U.S. citizen or meet Medicaid immigration rules, and you aren't entitled to Medicare. HCA says the income standards can change every April.

Other routes in:

• Apple Health for Kids covers children under 19. Free coverage reaches $4,896 a month for three; uninsured children above that can get coverage for $20 a child (family maximum $40) up to $6,034, or $30 a child (maximum $60) up to $7,218. Children on free coverage stay covered through the month they turn 6 regardless of income, and older children get 12 months of continuous eligibility.
• Apple Health for pregnant individuals, followed by After-Pregnancy Coverage for 12 months after a pregnancy ends.
• Classic Medicaid for people 65 and older, people who are blind or have a disability, people with Medicare, and people needing long-term services, decided by DSHS.

Noncitizen changes, October 1, 2026. HCA's H.R. 1 page says coverage for some refugee, asylee and other noncitizen adults changed on October 1, 2026. HCA also posted that a September 30 federal court order preserved Apple Health for more than 800 Washingtonians on SSI who were set to lose it that day.

Apple Health Expansion: Closed to New Enrollment

Apple Health Expansion is a state-funded program giving full-scope coverage to people 19 and older, with income up to 138% of poverty, who can't get other Apple Health because of immigration status, including people without status. Its income chart matches the adult chart, starting at $1,835 a month for one.

Its status as of November 13, 2026:

• Enrollment is closed. HCA says the enrollment cap has been met. Its December 2025 update says the state won't open enrollment while H.R. 1 changes are made, and that the governor's 2026 supplemental budget proposal would keep funding current enrollees and direct HCA to design a new limited benefit program for certain uninsured people. You can still apply to be considered if space opens.
• Fee-for-service from 2027. Starting January 1, 2027, the program moves from managed care to coverage without managed care. HCA says most benefits stay the same, but members will need providers who accept Apple Health fee-for-service.
• Who's left out. Immigrants still in a five-year waiting period for regular Apple Health aren't eligible, nor are people who are pregnant or within 12 months after a pregnancy (they move to pregnancy coverage).

HCA says it doesn't share client information with immigration agencies. Its page also reports that a federal court ruled on December 29, 2025 that CMS could give DHS limited data (name, status, address, phone, Medicaid ID) on people DHS lists as not lawfully present. The case is ongoing.

Managed Care Plans, Dental and Covered Services

Most Apple Health members are in a managed care plan, and HCA's managed care page lists 5 plans statewide (not every plan serves every area):

Source: HCA Apple Health managed care page (opens in a new tab), checked November 13, 2026.

Changing plans. You can change your plan at any time, according to HCA. The change usually takes effect the next month, unless you ask in the last 2 business days of the month. New members are enrolled the day they become eligible, backdated to the start of the month, and can pick a plan online at Healthplanfinder or be auto-assigned.

Covered services. HCA's covered services page lists doctor visits, emergency care, maternity and newborn care, mental health and substance use treatment, prescriptions, lab work, hospital stays, rides to appointments when needed, interpreters, children's dental and vision, and limited dental and vision for adults.

Dental runs outside your plan. Adult dental is paid directly by Apple Health using your ProviderOne card, not through your managed care plan. HCA's dental page lists exams and cleanings, fluoride, extractions, root canals on front teeth, dentures and partials, and stainless steel crowns for adults 21 and older; porcelain crowns, braces, implants and root canals on back teeth aren't covered. DentistLink (1-844-888-5465) finds a dentist.

Copays. None today for most services. HCA says that starting October 1, 2028, Apple Health for Adults members will pay up to $35 for many services, excluding primary care, behavioral health, emergency services and some rural care.

How to Apply for Apple Health, Step by Step

Your age and situation decide which of the 2 systems you use.

Step 1: Pick the right door

Source: HCA apply or renew page, checked November 13, 2026.

Step 2: Have this ready

HCA asks for household monthly income, dates of birth for everyone in the household, Social Security numbers for household members applying who have one, and immigration information if it applies.

Step 3: Know the clock

Under WAC 182-503-0060, HCA decides within 45 days, within 15 days if you're pregnant, and within 60 days if a disability decision is needed. If it needs more information, it sends a letter within 20 days of your application and gives you at least 10 days to answer. The federal limit in 42 CFR 435.912 (opens in a new tab) is 45 days, or 90 with disability.

Step 4: Card, plan and back coverage

Approved members get a ProviderOne services card in about 2 weeks, and coverage starts on the first day of the month you applied. If you have bills from the 3 months before, ask for retroactive coverage on the application: WAC 182-504-0005 allows it if you would have qualified then. That window shrinks on January 1, 2027.

For example, one applicant in Spokane, a 28-year-old line cook living alone who earns $1,700 a month, is under the $1,835 adult line. If she applies in February 2027, she'll need to show January activity: at roughly $1,700 in pay, she's well past the $580 income test, and her coverage would run 6 months instead of 12 (an illustration built from HCA's 2026 figures, not a real case).

Work Requirements and 6-Month Renewals From January 2027

Washington's work rule starts on January 1, 2027 and applies only to Apple Health for Adults. According to the HCA work requirements program page, you meet it with any of these in a month:

• At least $580 in monthly household income (seasonal workers can average over 6 months, per the June 2026 fact sheet).
• 80 hours of work, paid, in-kind or unpaid.
• Enrollment in an education program at least half-time.
• 80 hours in a work program, or 80 hours of community service.
• A combination adding up to 80 hours. HCA converts each credit hour to 13 monthly hours (6 credits count as 78).

Timing. When you apply, you must meet the rule (or an exemption) in the month before you apply; a current-month exclusion can count in the application month. When you renew, any one month during your certification period counts.

Who's exempt. HCA lists people under 19, people on Medicare or another Apple Health program, American Indians and Alaska Natives, pregnant and postpartum people, parents and caregivers of a child under 14 or a person with a disability, veterans with a total disability rating, people who are medically frail, people meeting SNAP or TANF work rules, people in drug or alcohol treatment, people incarcerated or released within 3 months, and young adults on the program for people who aged out of state care. Four short-term hardships also count: travel for serious medical care, an inpatient stay, a presidential disaster area, and a county with unemployment 1.5 times the national rate. HCA accepts your own statement that you're medically frail through 2027 and plans to verify it starting January 2028.

6-month renewals. Apple Health for Adults moves from 12-month to 6-month coverage periods at each person's first renewal in 2027. The fact sheet's example: someone approved on February 1, 2027 is covered through July 31, 2027. American Indians and Alaska Natives keep 12 months.

CMS's optional pause. On November 13, 2026, CMS announced an optional "hold harmless" period through June 30, 2027, during which a state that opts in still checks the work rule but doesn't deny or end coverage only for failing it. CMS's letter (SMD 26-006) asks states planning to use it from January 1, 2027 to tell CMS by December 11, 2026. HCA's pages, as checked November 13, 2026, don't say whether Washington will use it, so plan as if the rule applies. HCA's online survey can tell you whether it applies to you.

What HCA Doesn't Tell You

HCA's pages are detailed, but Grantsights analysis of them found 6 gaps worth knowing:

1. Back coverage shrinks on January 1, 2027. From 3 months to 1 for adults and 2 for others. If you have recent bills, apply before the new year.
2. January 2027 applicants need December proof. The month-before rule means someone who lost a job in November and applies in January must show December activity or an exemption.
3. Two systems, two phone numbers. A 66-year-old on Healthplanfinder or a 40-year-old on Washington Connection will be sent to the other door; start in the right one.
4. Dental isn't your plan's job. Your managed care plan can't fix a dental claim; adult dental runs on your ProviderOne card.
5. Apple Health Expansion members face a provider change. The 2027 shift to fee-for-service means checking whether your clinic takes Apple Health fee-for-service.
6. The hold harmless decision is still open. CMS's November 13, 2026 option could soften the first 6 months, but HCA hadn't posted a choice when Grantsights checked.

Common Mistakes and Red Flags

A common mistake is ignoring an HCA notice because it looks like a form letter. HCA says adults with current contact information will get notices about the work rule and renewals, and missing one can end coverage once 6-month renewals start.

Other ways Washingtonians lose or miss Apple Health:

• Missing a renewal deadline. HCA says if you're found eligible within 90 days after losing coverage, it covers the gap, so act fast. The quickest route is Healthplanfinder.
• Underestimating exemptions. A parent of a 12-year-old doesn't need to log hours but should keep the child on the application.
• Not reporting a pregnancy. It moves you to pregnancy coverage, faster processing (15 days) and an exemption.
• Leaving kids off because parents are over the line. Free kids' coverage runs about $1,754 higher for a family of three.
• Letting the 90-day hearing window pass.

Red flags: anyone who charges to help you apply, asks for your Healthplanfinder password, or texts asking for payment to "keep your Apple Health" is running a scam. Avoid paid enrollment services; navigators listed by Healthplanfinder help for free.

Hearings: 90 Days From the Decision

You have 90 days from the date of an Apple Health decision to request a hearing, per HCA's hearing guidance and RCW 74.09.741 (opens in a new tab); after that, an administrative law judge decides whether a late request counts. The request can be spoken or written and doesn't need a special form.

For Healthplanfinder (MAGI) decisions: call Healthplanfinder at 1-855-923-4633, HCA at 1-800-562-3022 or the Office of Administrative Hearings at 1-800-583-8271; fax 1-855-867-4467; email askmagi@hca.wa.gov; or write to HCA, PO Box 45531, Olympia, WA 98504.

For Classic Medicaid (DSHS) decisions: call 1-877-501-2233, visit or write your Community Services Office or Home and Community Services office, or write to DSHS Customer Service Center, PO Box 11699, Tacoma, WA 98411.

Read the reason on your letter first. A missing pay stub or a wrong household size is often the whole problem, and fixing it through Healthplanfinder can be faster than a hearing.

Other Help in Washington

Apple Health households often qualify for food and energy help too:

• Food: our Washington Basic Food (SNAP) guide covers applying and benefit amounts, and the Washington food stamps income limits guide has the income chart. Meeting Basic Food work rules also exempts you from the Apple Health work rule.
• Heating bills: see our Washington LIHEAP guide.
• Lost a job: the Washington unemployment benefits guide explains weekly benefits, which also count toward the $580 income test.
• Pregnancy and young children: HCA points to WIC at 1-800-322-2588.

Washingtonians checking for other programs can try Grantsights' free eligibility checker, which points to official programs. Only HCA and DSHS can approve Apple Health.

FAQ: Washington Apple Health

How do I apply for Apple Health in Washington?

Through Washington Healthplanfinder or 1-855-923-4633 if you're 19 to 64, a parent or pregnant; through Washington Connection or 1-877-501-2233 if you're 65 or older or need long-term care.

What is the Apple Health income limit for adults in 2026?

$1,835 a month for one, $2,490 for two, $3,142 for three and $3,795 for four.

When do Apple Health work requirements start?

January 1, 2027, for Apple Health for Adults members, with many exemptions.

Is Apple Health Expansion still open?

No; the enrollment cap is met, and the program moves to fee-for-service on January 1, 2027.

Which Apple Health managed care plans can I choose?

CHPW, Coordinated Care, Molina, UnitedHealthcare or Wellpoint Washington, where they serve your area; you can switch any time.

Does Apple Health pay for bills from before I applied?

Up to 3 months now; 1 month for adults and 2 for others from January 1, 2027.

How long do I have to request a hearing on an Apple Health decision?

90 days from the decision.

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Sources

1. HCA: Apple Health for Adults (individual adults) (opens in a new tab), checked November 13, 2026
2. HCA: Apple Health for Kids (opens in a new tab), checked November 13, 2026
3. HCA: Apple Health Expansion (opens in a new tab), checked November 13, 2026
4. HCA: Apple Health Expansion enrollment cap update (opens in a new tab), checked November 13, 2026
5. HCA: Apply for or renew coverage (opens in a new tab), checked November 13, 2026
6. HCA: Apple Health managed care (opens in a new tab), checked November 13, 2026
7. HCA: Getting dental care (opens in a new tab), checked November 13, 2026
8. HCA: Basic covered services (opens in a new tab), checked November 13, 2026
9. HCA: What the changes to Apple Health mean for you (opens in a new tab), checked November 13, 2026
10. HCA: Apple Health work requirements (opens in a new tab), checked November 13, 2026
11. HCA: Work requirements and renewals fact sheet, June 2026 (opens in a new tab)
12. HCA: Requesting an administrative hearing (opens in a new tab), checked November 13, 2026
13. WAC 182-503-0060: Processing time (opens in a new tab)
14. WAC 182-504-0005: Retroactive certification period (opens in a new tab)
15. RCW 74.09.741: Hearings (opens in a new tab)
16. CMS: Hold harmless period announcement, November 13, 2026 (opens in a new tab)
17. CMS: SMD 26-006, optional hold harmless period (November 13, 2026) (opens in a new tab)
18. Federal Register: community engagement interim final rule, June 3, 2026 (opens in a new tab)
19. eCFR: 42 CFR 435.912 (opens in a new tab)