Apple Health for Refugees

Revised date
Purpose statement

To describe the program rules for the Refugee Medical Program (RMA).

WAC 182-507-0130 Refugee medical assistance (RMA).

WAC 182-507-0130 Refugee medical assistance (RMA)

Effective November 13, 2022

  1. You are eligible for refugee medical assistance (RMA) if all the following conditions are met. You:
    1. Meet immigration status requirements of WAC 182-507-0135;
    2. Have countable resources below $1,000 on the date of application;
    3. Have countable income equal to or below 200 percent of the federal poverty level (FPL) on the date of application.  The following income is not considered when determining eligibility for RMA:
      1. Resettlement cash payments made by the voluntary agency (VOLAG);
      2. Income of a sponsor is not counted unless the sponsor is also part of your assistance unit; and 
      3. Income received after the date of application.
    4. Provide the name of the VOLAG which helped bring you to the United States so that the department of social and health services (DSHS) can promptly notify the VOLAG (or sponsor) about the medical application.
  2. If you receive refugee cash assistance (RCA) you are eligible for RMA as long as you are not otherwise eligible for medicaid or a children's health care program as described in WAC 182-505-0210. You do not have to apply for or receive RCA in order to qualify for RMA.
  3. You are not eligible to receive RMA if you are:
    1. Already eligible for medicaid or a children's health care program as described in WAC 182-505-0210;
    2. A full-time student in an institution of higher education unless the educational activity is part of a DSHS-approved individual responsibility plan (IRP); or
    3. A nonrefugee spouse of a refugee.
  4. If approved for RMA, the agency or its designee issue an approval letter in both English and your primary language. The agency or its designee also sends a notice every time there are any changes or actions taken which affect your eligibility for RMA.
  5. You may be eligible for RMA coverage of medical expenses incurred during the three months prior to the first day of the month of the application. Eligibility determination will be made according to medicaid rules.
  6. If you are a victim of human trafficking you must provide the following documentation and meet the eligibility requirements in subsections (1) and (2) of this section to be eligible for RMA:
    1. Adults, 18 years of age or older, must provide the original certification letter from the United States Department of Health and Human Services (DHHS). No other documentation is needed. The eligibility period will be determined based on the entry date on your certification letter;
    2. A child victim under the age of 18 does not need to be certified. DHHS issues a special letter for children. Children also have to meet income eligibility requirements;
    3. A family member of a certified victim of human trafficking must have a T-2, T-3, T-4, or T-5 visa (derivative T-Visas), and the family member must meet eligibility requirements in subsections (1) and (2) of this section.
  7. The entry date for an asylee is the date that asylum status is granted. For example, you entered the United States on December 1, 1999, as a tourist, then applied for asylum on April 1, 2000, interviewed with the asylum office on July 1, 2000, and were granted asylum on September 1, 2000. The date of entry is September 1, 2000, and that is the date used to establish eligibility for RMA.
  8.  
    1. (a) RMA ends on either:
      1. The last day of the eighth month from the month the person entered the United States if they entered the United States on or before September 30, 2021. For example, if they entered the United States on September 30, 2021, they are eligible through April 30, 2022; or
      2. The last day of the 12th month from the month the person entered the United States if they entered the United States on or after October 1, 2021. For example, if they entered the United States on October 25, 2021, they are eligible through September 30, 2022.
    2. You may receive RMA benefits for more months if you are in a category of persons for whom the federal Office of Refugee Resettlement has extended the eligibility period.
  9. If you are approved for RMA you are continuously eligible through the end of the initial RMA certification period, regardless of an increase in income.
  10. The agency, or its designee, determines eligibility for medicaid and other medical programs for your spouse when the spouse arrives in the United States. If the spouse is not eligible for medicaid due to your countable income, the spouse is still eligible for RMA under subsection (8) of this section.
  11. If you disagree with a decision or action taken on the case by the agency, or its designee, you have the right to request a review of the case action(s) or request an administrative hearing (see chapter 182-526 WAC). The request must be received by the agency, or its designee, within 90 days of the date of the decision or action.        

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

WAC 182-507-0135 Immigration status requirement for refugee medical assistance (RMA).

Effective November 24, 2024

  1. An individual is eligible for refugee medical assistance (RMA) if the individual provides documentation issued by the United States Citizenship and Immigration Services (USCIS) to show that the individual is:
    1. Admitted as a refugee under section 207 of the Immigration and Nationalities Act (INA);
    2. Paroled into the United States as a refugee or asylee under section 212 (d)(5) of the INA;
    3. Granted conditional entry under section 203 (a)(7) of the INA;
    4. Granted asylum under section 208 of the INA;
    5. Admitted as an Amerasian immigrant from Vietnam through the orderly departure program, under section 584 of the Foreign Operations Appropriations Act, incorporated in the FY88 continuing resolution P.L. 100-212;
    6. A Cuban-Haitian entrant who was admitted as a public interest parolee under section 212 (d)(5) of the INA;
    7. Certified as a victim of human trafficking by the federal Office of Refugee Resettlement (ORR);
    8. An eligible family member of a victim of human trafficking certified by ORR who has a T-2, T-3, T-4, or T-5 visa; 
    9. Admitted as special immigrant from Iraq or Afghanistan under one of the following:
      1. Special immigrant status under section 101 (a) (27) of the INA;
      2. Special immigrant conditional permanent resident; or 
      3. Parole under section 602 (b) (1) of the Afghan Allies Protection Act of 2009 or section 1059 (a) of the National Defense Authorization Act of 2006;
    10. An Afghan granted humanitarian parole between July 31, 2021, and September 30, 2023, their spouse or child, or a parent or guardian of an unaccompanied minor who is granted parole after September 30, 2022 under section 2502 of the Extending Government Funding and Delivering Emergency Assistance Act of 2021; or
    11.  A citizen or national of Ukraine (or a person who last habitually resided in Ukraine) who, under section 401 of the Additional Ukrainian Supplemental Appropriations Act, 2022 (AUSAA) and the Ukraine Security Supplemental Appropriations Act, 2024 (USSAA), is evaluated as a qualified alien when:
      1. Granted parole into the United States between February 24, 2022, and September 30, 2024; or
      2. Granted parole into the United States after September 30, 2024, and is:
        1. The spouse or child of a person described in (k)(i) of this subsection; or
        2. The parent, legal guardian or primary caregiver of a person described in (k)(i) of this subsection who is determined to be an unaccompanied child under section 462 (g) (2) of the Homeland Security Act of 2002 or section 412 (d) (2) (B) of the Immigration and Nationality Act. 
  2. A permanent resident alien meets the immigration status requirements for RCA and RMA if the individual was previously in one of the statuses described in subsection (1) of this section.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying information

  1. Refugees and other humanitarian immigrants as described in WAC 182-507-0135 may be eligible for RMA if they are not eligible for Apple Health (Medicaid).
  2. RMA eligibility is established based on an applicant's income and resources on the date of the application, rather than averaging income over the application processing period.

            a. Income received after the date of application for RMA is not considered when determining eligibility for RMA.

      3. A student enrolled in an institution of higher education and carrying a full-time academic workload is considered a full-time student. A full-time student is eligible for RMA only if educational activity is a part of their WorkFirst personal employment plan.

For an overview of citizenship and immigration status eligibility rules, see the Citizenship and Immigration Status Guide.

Worker responsibilities

For applicants as described in WAC 182-507-0135 who are under age 65, HCA determines eligibility for modified adjusted gross income (MAGI)-based Apple Health programs first.

  1. Applications for medical assistance should be submitted through Healthplanfinder. If you experience an issue when submitting the application, complete a paper application and email it to HCA WAHRMA apps​ and include:
  • Primary applicant name
  • Healthplanfinder app ID
  • Managed care organization (MCO) plan selection (optional)
  • Error code (if any)

           a. If an applicant is not eligible for MAGI-based Apple Health, or they become ineligible during the certification period, HCA will determine eligibility for Refugee medical assistance.

           b. DSHS determines eligibility for medical assistance for clients over age 65 who are refugees or have other eligible immigration statuses.

       2. Applicants age 65 or older, with blindness or disability, as described in WAC 182-507-0135, complete applications:

  • In person at a local DSHS CSO,
  • Online at Washington Connection,
  • Faxed to CSD at 1-888-338-7410, or
  • Mailed to DSHS - CSD Customer Service Center, PO Box 11699, Tacoma WA 98411-6699

List of Refugee Resettlement Agencies in Washington State.

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