Apple Health for Adults

Revised date

WAC 182-505-0250 Washington apple health -- MAGI-based adult medical.

WAC 182-505-0250 Washington apple health -- MAGI-based adult medical.

Effective August 29, 2014.

  1. Effective on or after January 1, 2014, a person is eligible for Washington apple health (WAH) modified adjusted gross income (MAGI)-based adult coverage when he or she meets the following requirements:
    1. Is age nineteen or older and under the age of sixty-five;
    2. Is not entitled to, or enrolled in, medicare benefits under Part A or B of Title XVIII of the Social Security Act;
    3. Is not otherwise eligible for and enrolled in mandatory coverage under one of the following programs:
      1. WAH SSI-related categorically needy (CN);
      2. WAH foster care program; or
      3. WAH adoption support program;
    4. Meets citizenship and immigration status requirements described in WAC 182-503-0535;
    5. Meets general eligibility requirements described in WAC 182-503-0505; and
    6. Has net countable income that is at or below one hundred thirty-three percent of the federal poverty level for a household of the applicable size.
  2. Parents or caretaker relatives of an eligible dependent child as described in WAC 182-503-0565 are first considered for WAH for families as described in WAC 182-505-0240. A person whose countable income exceeds the standard to qualify for family coverage is considered for coverage under this section.
  3. Persons who are eligible under this section are eligible for WAH alternative benefit plan as defined in WAC 182-500-0010 coverage. A person described in this section is not eligible for medically needy WAH.
  4. Other coverage options for adults not eligible under this section are described in WAC 182-508-0001.

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. Adults who are over income for Apple Health for Families (N01) may be eligible for Apple Health for Adults (N05) as described in WAC 182-505-0250.
  2. Adults who are ineligible for Apple Health for Adults (N05) based on citizenship may be eligible for Alien Emergency Medical (N21/N25) as described in WAC 182-507-0110.
    1. Learn about Health Care Authority's plan for Apple Health Expansion.
  3. Individuals receiving or eligible for Medicare or who are age 65 or older, are not eligible for Apple Health for Adults (N05).
    1. Adults who are low income may qualify for Apple Health for Families and Caretakers even if they are 65+ or eligible for Medicare. See WAC 182-505-0240.
    2. Pregnant adults who are eligible for or receiving Medicare can get Apple Health for Pregnant Individuals. See WAC 182-505-0115.

Individuals may apply for MAGI Medicaid using the following options:

  • Online: Go to Washington Healthplanfinder - select the "Apply Now" button.
  • Mobile app: Download the WAPlanfinder app - select "sign in" or "create an account".
  • Phone: Call the Washington Healthplanfinder Customer Support Center at 1-855-923-4633.
  • Paper: Submit an Application for health care coverage (18-001P).
  • In-person: Local resources who, at no additional cost, can help you apply for health coverage.
  • Local enrollment assistance

For assistance in applying for Apple Health through the Washington Healthplanfinder contact a navigator or call Healthplanfinder Customer Support at 1-855-923-4633.

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