Clarifying Information
Changes That Need to Be Reported for All Apple Health Programs
Change in residential address
Individuals must report any residential address change, out of state move or establishment of housing.
Change in mailing address
Individuals must report any change in their mailing address.
Change in marital status
Individuals must report any change in marital status.
When family members or dependents move in or out of the residence
Individuals must report when family members or dependents move in or out of the residence.
Pregnancy
Individuals should report pregnancy and pregnancies that ended within the last 12 months.
Incarceration
Incarceration of any individual in the household must be reported.
Change in institutional status
Change in institutionalization as described in WAC 182-500-0050, means an individual residing in an "institution" for 30 days or more or discharging from an institution. If an individual moves from one institution to another without being discharged, that person retains their status of being institutionalized. Institutions include a hospital and correctional facilities.
Change in health insurance coverage including Medicare eligibility
Individuals need to report gaining or losing nonpublic health care coverage, such as employee-sponsored insurance, or Medicare coverage. Although, individuals on an Apple Health program do not need to report changes from one Apple Health program to another Apple Health program, or from one Apple Health Managed Care Plan to another Apple Health Managed Care Plan.
Change in immigration or citizenship status
Individuals should report any change to their immigration or citizenship status.
Worker Responsibilities
MAGI-Based Apple Health |
Classic Medicaid (Aged, Blind, Disabled (SSI-Related and Long-Term Care) |
See Update my address or income (report a change)
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See Update my address or income (report a change) |
Taking action on changes:
- When information about someone's circumstances becomes known: determine the impact on the person's coverage. This may include contacting them, contacting other parties, or asking for proof of their circumstances.
- Individual Reports: Take action based on changes the person reports by entering the changes into the Healthplanfinder.
- Third Party Reports: If we receive information from a third party, follow-up to decide how the information affects the person's/household's health care coverage. This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 182-503-0050 Verification Requirements for Apple Health.
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Taking action on changes:
- When information about someone's circumstances becomes known: determine the impact on the person's benefits. This may include contacting them, contacting other parties, or asking for proof of their circumstances.
- Individual Reports: Take action based on changes the person reports by entering the changes into ACES.
- Third Party Reports: If we receive information from a third party, follow-up to decide how the information affects the person's/household's health care coverage. This may include contacting the person, contacting other parties, or asking for proof of their circumstances under WAC 182-503-0050 Verification Requirements for Apple Health.
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When a change happens:
- The date of the change is normally the date a change occurs, such as when someone gets married, a newborn comes home from the hospital, someone moves to a new home.
- However, the date of a change in income is the date someone receives the newly reported income, such as a first paycheck that reflects a wage increase or a first paycheck for a new job.
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When a change happens:
- The date of the change is normally the date a change occurs, such as when someone gets married, a newborn comes home from the hospital, someone moves to a new home.
- However, the date of a change in income is the date someone receives the newly reported income, such as a first paycheck that reflects a wage increase or a first paycheck for a new job.
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Effect of a reported change:
- If a reported change results in a change in coverage, the change takes place on the first of the month following the month in which the change is reported, after advance and adequate notice has been given.
- Unlike in ACES, Healthplanfinder does not have the functionality to enter a change into a specific month. If an individual reports a change early, the worker should keep in mind that the change should not be entered into Healthplanfinder before the month in which the change takes place.
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Effect of a reported change:
- If a reported change results in a change in coverage, the change takes place on the first of the month following the month in which the change is reported, after advance and adequate notice has been given.
- In ACES, the worker can enter a change in the month that the change is reported to take place, including a future month.
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Changes reported via Apple Health medical application, renewal, or redetermination:
- The worker can use an application or renewal at any time to update the certification period.
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AU member moves out of Washington State:
- Individuals must be residents of the state in order to be eligible for health care coverage under any Apple Health programs.
- If one or more members of the household (but not the entire household) leave the state, they may still be eligible for Apple Health. Refer to WAC 182-503-0520 Residency Requirements, to determine eligibility for the people who left the state.
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AU member moves out of Washington State:
- Individuals must be residents of the state in order to be eligible for health care coverage under any Apple Health programs.
- If one or more members of the household (but not the entire household) leave the state, they may still be eligible for Apple Health. Refer to WAC 182-503-0520 Residency Requirements, to determine eligibility for the people who left the state.
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Example: Sandy is hired for a new job on May 31st, begins work on June 10th, and receives her first paycheck on July 5th. As this is an income change, the date of Sandy's first paycheck, July 5th, is the date of the change. Sandy must report this change by August 5th based on WAC 182-504-0105 Reporting Requirements. If Sandy reports this change earlier (other than her reporting the change in Healthplanfinder), the worker should make sure the effective date of the change is when her first check is expected.