Apple Health Expansion

Revised date
Purpose statement

Apple Health Expansion (AHE) is a state funded, capped enrollment (limited enrollment due to funding) program for individuals who do not meet the citizenship or immigration status requirements of other Apple Health programs.

Who may be eligible?

  • Washington residents aged 19 or older,
  • Have countable income at or below 138% of the federal poverty level (FPL),
  • Do not qualify for other Apple Health programs based on immigration status,
  • Are not pregnant or did not have a pregnancy end in the last 12 months, and
  • Are not eligible for qualified health plans with advance premium tax credits (APTC), federally funded medical assistance programs.
  • Are not eligible for another Apple Health program

What is the financial eligibility for AHE?

There are no resource limits for the AHE program. Clients will need to have income at or below 138% of the FPL. For the current 2024 FPL income standards by household, visit the Apple Health Expansion program webpage.

How to apply

Individuals who are 65 or older apply through the Department of Social and Health Services (DSHS)

Individuals who are under the age of 65 apply through Washington Healthplanfinder (HPF)

For more information, visit the Apple Health Expansion program webpage.

Both the Health Care Authority (HCA) and DSHS will process AHE applications. Clients aged 19-64 will be automatically processed in HPF (and all other acceptable application pathways) giving either an approval or denial based on the attested information of the client. For individuals aged 65+ DSHS will process their application coming through Washington Connection and all other acceptable application pathways and give either an approval or denial based on the confirmed information of the client.

What if the cap is on?

If the CAP is on, with EPICS approval, HCA and DSHS may manually process and approve applications for AHE.

HCA – MAGI Apple Health Expansion (AHE) worker responsibilities

HCA processes AHE applications under MAGI when:

  • Individual is age 19 through 64.
  • Individual is not eligible for Medicare, or any other federally funded Apple Health programs, and follows MAGI rules established through the Healthplanfinder.
  • If AHE has open availability individuals will be approved if they meet all eligibility requirements for the program.

Processing the application manually due to CAP being on

  1. Review the individual's income and immigration status to ensure they are not eligible for any other federally funded MAGI programs.
  2. Is the client eligible for Apple Health Expansion based on attested information:
    1. If yes, continue with manual application processing
    2. If no, sends denial letter (If one has not already auto generated from HPF Dashboard) for AHE.
      1. Did client mark AEM? If yes client will be reviewed for AEM eligibility
  3. If client is determined eligible for AHE staff manually approves client and sends approval letter.

"Submit information" letter

If attested income does not verify, verify important deadline to submit information letter generates.

Immigration status

If attested immigration status does not match information on file (i.e. attests to no immigration status but there is information on file, or attested immigration status does not verify), follow SAVE verification procedures.

Clarifying information

Clients who are Federally Qualified (FQ) or Non-Federally Qualified (NF) are not eligible for AHE.

Clients who have not yet met their five-year bar are not eligible for AHE. This is due to being eligible for Qualified Health Plans with Advance Premium Tax Credits. These individuals could also be looked at for Alien Emergency Medical (AEM).

There are no retro benefits for AHE. If retro is requested staff may look at AEM for retro months.

AHE does not include long-term services and supports (LTSS) authorized by the Developmental Disabilities Administration (DDA), Aging and Long-term Supports Administration (ALTSA), or Home and Community Services (HCS) in the scope of care benefit package.

Clients also currently active on Medical Care Services (MCS) coverage are not eligible for AHE coverage as they would be dual-enrolled in coverage.

Classic Apple Health Expansion Worker responsibilities

Classic AHE applications are only processed by Community Services Division (CSD) specialized staff.

If the program cap has not been met, clients will be approved if eligible. If the limit (cap) is at capacity, eligible clients will be denied. Clients may qualify for other coverage including Alien Emergency Medical (AEM) and can purchase a QHP plan through the Health Benefits exchange (HBE).

DSHS-Classic Apple Health Expansion (S20)

DSHS-CSD processes AHE under Classic Apple Health when the individual is age 65 or older.

The following immigration status’ are eligible for AHE:

  • Undocumented / No immigration status
  • Applicants for asylum
  • Applicants for withholding of deportation/removal
  • Registry applicants
  • Order of supervision
  • Applicant for cancellation of removal / Suspension of deportation
  • Expired or revoked immigration status

Household composition-AHE (S20) will follow the same household composition rules as S02:

  • Income: Countable Earned and Unearned income types are the same as S02/S07 medical.
  • SSI recipient spouse: If an AHE applicant is married and their spouse is an SSI recipient, they are not eligible for AHE.
  • When there are two applying spouses on the same AU and they're eligible for different programs, only one spouse will be approved for coverage on the AU.

Example

  • John and Beth apply for medical on 7/1/24.
  • John is a 70-year-old citizen and Beth is 65 and does not have legal status.
  • A worker screens in S02 for John and S20 for Beth, with both clients having financial responsibility Applicant (PN).
  • During Finalize the S02 is approved for John with certification 7/1/24 - 6/30/25.
  • Beth's financial responsibility is changed from Applicant (PN) to Ineligible Spouse (SP).
  • During the finalize for the S20 John would be ineligible spouse (SP) and Beth would be applicant (PN).
  • If there is a spot available and Beth is eligible, she would be approved S20 on AHE.

Enrollment CAP

  • The CSD specialized medical team has cap override access in ACES. This field is displayed on the AU details screen in ACES 3G
  • All S20 requests processed after the cap has been met shall be denied for Reason Code (171) Enrollment Cap regardless of the date of application or when it was received as long as the AEM indicator = N and they aren't eligible for a Classic Medical Program. (Trickle to pending AEM if AEM indicator = Y.)

Asset Verification System (AVS)

  • S20 is not subject to asset test and therefore is required for AVS. S20 clients and AUs will not be included in the AVS application file. However, the AVS authorization field will display in ACES 3G when S20 is screened. If you have AVS authorization, update this field, if you do not, you are able to bypass.
  • AVS authorization field displays because if S20 trickles to S07. AVS authorization is required for S07 approval.

Submitting an application

DSHS Classic Apple Health Expansion

  • Staff screen in the application and can select the program code (S02, S20). Based on information entered in ACES, the program will trickle to the appropriate program.
    • Example: S02 is screened, but client is eligible based on immigration status and income for S20- ACES will trickle to S20
    • Example: S20 is screened, but based on immigration status and income entered the client is eligible for Federal Medicaid. S20 trickles to S99.

Attestation acceptance

Client attestation of all eligibility factors will be accepted.

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