Medicaid Eligibility in Washington

Calendar Icon Updated February 11, 2019
Medicaid

You  may have heard of Washington Medicaid by its other name – Apple Health.  Medicaid is a health program that is run by both the state and the  federal government together. It is offered to low-income Washington  residents so that they are able to get the health services that they  need at a low cost or even free. It even provides preventive care such  as treatments for diabetes and high blood pressure.

Washington’s Requirements for Medicaid Qualification

People who are interested in finding out how to qualify for Medicaid  will come to find that there are both financial and personal requirements. The state will determine eligibility based on whether or  not the household income requirements are met as well as by comparing  medical circumstances of the people applying with the guidelines set by  the program. Medicaid takes different patient groups and to qualify for  the program, you will have to fall into one of the following:

  • Children under 18 who have a household income that falls below the threshold for free or low-cost benefits
  • Pregnant women need to have an income below the Federal Poverty  Level (FPL). This coverage will end 60 days past the birth of the child.
  • Legal guardians, caretakers, and parents have to reside with children under 18 while also meeting the income requirements
  • Disabled, blind, or aged applicants have to meet both medical and income requirements

Patients who are disabled might also be eligible for HWD  (Healthcare for Workers with Disabilities). If they are older than 16  yet younger than 64 they will need to have an income that is less than  220% of the FPL. They will also have a premium that is on a sliding  scale and will never be more than 7.5%.

How to Apply for Medicaid in in Washington

In Washington, there are several methods when it comes to applying  for Medicaid. That said, you should first find out if you will be able  to qualify. You should also make sure that you have the required  documentation before you apply. The application is one that is lengthy  and to ensure that you get everything done efficiently, you should be  prepared. You will need the following things:

  • Proof of the full legal name for each household member
  • Social Security Number for each household member
  • Current address
  • Annual income as evidenced by documents providing proof of income
  • Phone number
  • Legal presence papers or citizenship documentation
  • Proof of residency in Washington
  • If you currently have health insurance, you will need information regarding it
  • Any known medical conditions
  • All of these things for each member of the household

People looking to apply for Medicaid in Washington can do so in person, by phone, by mail, or online.

The Washington Medicaid Application can be found at the Washington HealthPlan Finder site for those who wish to apply online. For a paper application to  fill out and send in or to take to your local Medicaid office, you can  click here.  If you decide that you would like to apply by phone (a lengthy  process), you can call 855-923-4633 and one of the representatives will  be able to guide you through the process. Please be sure to have all of  the required information (as listed above) handy when you call to ensure  that the process is easier and less time consuming for both you and the  representative helping you.

What Does Medicaid Cover in Washington?

Coverage caters to a variety of medical services. This can include  anything from dental and vision care to prescriptions, X-rays, labs, and  hospitalization. Other services that might be covered, depending on the  plan you choose, are treatment for chemical and alcohol dependency,  interpreters for appointments for people who don’t speak English, doctor  appointments, newborn and maternity care, and mental health services.

Income Requirements for Washington Medicaid

Medicaid in Washington requires household earnings thresholds for  nearly every health program. To determine the requirements, you have to  look at the group you belong in along with the size of the household.

When calculating the income requirements, you include the income for  the entire household, not just a single person. You will also need to  list all of the birthdays and SSNs for each member of the household.

For people who are between the ages of 20 and 64, the income needs to  fall below 133% of the FPL for their size household. Legal guardians,  caretakers, and parents who live with children under 18 have a variety  of thresholds.

You can find out what the limits are for your situation at the Washington State Health Care Authority site.

How Much Does Medicaid Cost in Washington?

Medicaid costs for Washington residents will vary depending on the  group you fall into and the plan you choose. Because you have to be low  income to even qualify, these costs will not be much. There are a  variety of programs that will provide medical service at low costs or  even free. The majority of people will have to choose an MCO (Managed  Care Organization). Most of the time, all of the services will be  included, but some services will be paid through what is known as a “fee  for service”.

Cost and Coverage of Medicaid in Washington – There are a variety of  programs that provide free or low-cost medical services to people who  are eligible. Apple Health offers complete coverage for major medical.  Apart from that, there are a few other programs that will come with  benefits that are limited.

Prescription Drugs with Medicaid in Washington?

Prescription drugs are covered by Washington Medicaid. Depending on  the plan you choose and your medical needs, generic medicine will be  preferred when it is available. Some prescriptions might have a small  copay while others will be free.

Which Medicaid plan is best in Washington?

Many different programs are available to choose from. You will be  given options based on your location and medical needs. Weigh the  options and choose accordingly. No one program will be the best option  for everyone.

Eligibility Team

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