Apple Health (Medicaid) FAQs

Apple Health is Washington state’s Medicaid program. It provides free or low-cost health care coverage to Washington residents who meet the eligibility requirements.

Apple Health has different programs, and each has its own eligibility requirements. Eligibility may depend on factors such as age, income, household size, and immigration status.

To stay covered, you must renew when Apple Health (the state) asks you to and continue to meet all eligibility rules. If you are no longer eligible for one program, you may still qualify for Apple Health under a different program.

Find the name of your Apple Health program on your CHPW Member ID card. You can also find it by signing in to your Washington Healthplanfinder™ account.

You don’t need to know the name of your Apple Health program, but it may be helpful for understanding your benefits and if changes to eligibility rules could impact your coverage.

The state will send you notices if there are changes happening to your program or if they need more information to confirm your eligibility.

Keep your contact information up to date in your Washington Healthplanfinder account and with CHPW if you are a member.

Report changes within 60 days after the change to help you stay covered:

• Change in address, income, or household size
• Change in immigration or citizenship status
• Marriage or divorce
• Pregnancy or pregnancy ended in the last year
• Receiving cancer treatment, anti-rejection medication, dialysis, or emergency medical services
• If anyone in your household is incarcerated

Sign in to your Washington Healthplanfinder account to report changes or learn more about reporting changes.

It can be difficult to find coverage that meets your health care needs. Consider the following qualities when shopping for Apple Health insurance:

• Benefits offered — Check whether the plan covers the health care services and medications you need. Apple Health plans must meet certain standards, but they’re not all the same.
• Provider network — Find out if your doctor clinic, hospital, or pharmacy is in the plan’s network. If you already have a doctor, make sure they accept the insurance you’re considering. Check CHPW’s provider network ➔
• Value-added benefits — Many health insurance companies, including CHPW, offer different programs and services at no cost to members in addition to Apple Health benefits to support long-term health. Explore CHPW’s Benefits+ ➔

If you have CHPW Apple Health or Behavioral Health Services Only (BHSO), covered services and programs that are delivered by an in-network provider cost you nothing. In most cases, you also pay nothing monthly to stay covered (premiums)* as long as you remain eligible and enrolled.

If you receive non-emergency care from an out-of-network provider without pre-approval (prior authorization) from CHPW and a referral from your primary care provider, you will likely have to pay the full cost of the services provided.

*If your child has Apple Health for Kids coverage, you may pay a low monthly premium. Whether or not you pay a premium depends on your income. Check income requirements for Apple Health for Kids.

If you live in Washington state, yes! Community Health Plan of Washington offers Apple Health (Medicaid) coverage in ALL 39 counties in Washington state.

HMOs (Health Maintenance Organizations) and EPOs (Exclusive Provider Organizations) may disallow coverage to providers outside their networks. This lets them keep their premiums lower than other kinds of plans.

CHPW is an HMO. We’re proud of our network across Washington state and the care they provide our members.

PPOs (Preferred Provider Organizations) or POSs (Point-of-Service Plans) give you a choice of getting care within or outside of the provider network, although the costs are usually higher if the care is out-of-network.

FFSs (Fee-for-Service Plans) usually don’t have networks. That means you can see any doctor you choose, but you may have to pay more and fill out extra paperwork.

We contract with more than 2,700 primary care providers and more than 14,700 medical specialists.

To find out if your current doctor is in the CHPW provider network, search our online directory. You can also call CHPW Customer Service, 8 a.m. to 5 p.m., Monday through Friday.

If you live in Washington state, and meet all other eligibility requirements, you may qualify for Apple Health regardless of immigration status if any of the following apply to you:

• Under age 19 years (full coverage)
• Currently pregnant
• Had a pregnancy end within the last 12 months
• Receiving cancer treatment, anti-rejection medication, or dialysis
• Receiving or recently received emergency medical services

As of October 01, 2026, federally funded full Apple Health (Medicaid) is limited to:

• Green card holders who have met, or are exempt from, the 5-year waiting period
• Cuban and Haitian immigrants
• COFA migrants (people from Micronesia, Marshall Islands, Palau)
• U.S. citizens, U.S. nationals, and qualifying American Indians born abroad

To find out which type of coverage you currently qualify for, call our Renewal Team at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m. You can also check by applying for coverage online through Washington Healthplanfinder or working with a Navigator at your clinic.

Washington state will contact you before your coverage ends. Respond right away if they ask for more information. You may qualify for a different Apple Health program.

To make sure you do not miss important notices, update your contact information right away with both CHPW by completing this form and in your Washington Healthplanfinder account (the state) and watch for notices by mail and email.

If you need help understanding a notice you receive or help reviewing your health insurance options, contact our friendly Renewal Team right away so you do not miss a deadline at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m.   

Some Apple Health programs are available regardless of immigration status, if you meet the eligibility requirements, including:

• Apple Health for Pregnant Individuals
• After-Pregnancy Coverage (APC)
• Family Planning Only (FPO)
• Emergency Medical (AEM)
• Refugee Medical Assistance (RMA)
• Long-Term Services and Supports (LTSS) for noncitizens
• Medical Care Services (MCS)
• Apple Health Expansion (Enrollment limit currently met)

To qualify for federally funded full Apple Health (Medicaid) coverage, there are specific immigration status requirements.

If you are not eligible for Apple Health, anyone living in Washington state can shop for and buy a health plan through Washington Healthplanfinder, like CHPW’s Individual & Family Cascade Select Plans.

Even if you do not qualify for federal savings, you may still qualify for state‑based Cascade Care savings to help with the monthly cost (premiums). Learn more about Individual & Family Plans.

Apple Health renewal is when people who get Apple Health coverage are asked to verify they still qualify. Eligibility depends on factors that include:

• Age
• Income
• Household size
• Immigration status

New: Starting January 2027, everyone on Apple for Adults will need to renew their coverage every 6 months, instead of 12. They will also need to meet a new work requirement, unless they qualify for an exemption.

All other Apple Health programs will continue with 12-month renewals and will not have a work requirement to stay eligible.

If you are enrolled in Apple Health coverage, your plan must be renewed routinely to verify you are still eligible.

Sometimes you may need to take action to renew. Other times, your coverage could renew automatically if the state has enough information to verify you are still eligible.

If you need to take action, the state will send you a renewal notice. Open, read, and respond to renewal notices right away so you have the best chance of staying covered. For help, call our friendly Renewal Team at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m.

Your renewal date is based on when you enrolled.  As of January 2027, all Apple Health for Adults members must renew their coverage every 6 months.

All other Apple Health programs will continue to have a 12 month renewal cycle.

To make sure you do not miss an important notice, keep your contact information up to date:

1. Confirm your information with CHPW by completing this form.
2. Sign in to your Washington Healthplanfinder account and make sure your mailing address, phone number, and email are correct.
3. Watch for notices from the state, open and read your mail carefully, and respond quickly if you are asked for information.

You can renew online, over the phone, or by mail. Learn how to Renew Your Apple Health (Medicaid) Coverage.

If you or someone in your household does not renew on time, your Apple Health coverage would end. This could mean having to pay out-of-pocket for prescription medication or health care appointments.

To avoid gaps in coverage or losing your health insurance, act right away when you receive a renewal notice. Follow the instructions in the notice carefully and ask for help if you need more information.

If you are not sure what you need to do to renew, contact our Renewal Team right away at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m.

If you are still eligible and re-enroll in an Apple Health plan, your new plan may help pay for covered services you got in-network, before you were enrolled. How far back your coverage goes, and what is covered, depends on your Apple Health program.

As of January 1, 2027, your plan may pay for health care you received before you apply up to:

• 1 month for Apple Health for Adults
• 2 months for Other Apple Health programs

If you miss a deadline or are not sure what you need to do to renew,  contact our Renewal Team right away at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m. We can help you re-enroll or review your health insurance options.

It depends. After January 1, 2027, only people enrolled in Apple Health for Adults who do not qualify for an exemption will need to meet the new federal work requirement before they apply or renew.

See When do I need to renew?

You do not need to meet this requirement if you are:

• On any Apple Health program other than Apple Health for Adults
• American Indian/Alaska Native (AI/AN) or part of certain Tribal communities
• Pregnant or within 12-months postpartum
• Under age 19, foster youth, former foster youth under age 26, or age 65 or older
• Parent, caretaker, or a guardian of a child under age 14 or an individual with a disability
• On SNAP (food assistance) or TANF (cash assistance)
• Incarcerated or within 90 days of being released
• Medically frail or have a disability, including receiving alcohol or substance use disorder treatment (AUD/SUD)
• In a short-term hardship
• Entitled to Medicare Part A or B
• Disabled veteran with 100% total disability

For the full list, visit Washington State Health Care Authority (HCA)’s website

We can help you navigate how to meet this requirement or if you meet an exemption. Call our Renewal Team for help at 1-866-907-1904 (TTY:711) 8 a.m. to 5:30 p.m.

As of January 2027, Apple Health for Adults members (ages 19–64) must meet a work requirement unless they qualify for an exemption. This eligibility requirement can be met in any of the following ways:

• Completing at least 80 hours a month of work, community service, or a work program
• Enrolling in an educational program at least half-time
• Combining the above activities to total at least 80 hours a month
• Or having a monthly household income of at least $580

The work requirement or an exemption must be met in the month before applying, or any of the 6 months before renewing coverage.

You do not have a work requirement if you are on any other Apple Health program or if you qualify for an exemption.

Your primary care clinic is the first place to go for care, unless you have an emergency or need same day urgent care.

• To get your clinic’s information as a CHPW member, check the front of your CHPW Member ID card. If you need to change your clinic or your primary care provider, sign in to your myCHPW member portal or call us for help.
• To find an in-network urgent care provider, select “Urgent Care” under “Provider Type” in our Provider Search Tool.

If you already have health coverage through another program, like Medicare, Tribal Health, or Foster Care, you can get additional coverage just for mental health and substance use disorder services through CHPW’s Apple Health BHSO plan. You won’t have copays for services that are covered or approved from in-network providers.

• Substance use disorder services include assessment, detox, medication for opioid use disorder (MOUD), inpatient residential treatment, and outpatient treatment.
• Mental health services include evaluation, medication management, stabilization services, family treatment, and crisis services.
• Other services include emergency services, hospital services, evaluations, and lab services.

For more BHSO covered services, call us or review the Behavioral Health Service Only (BHSO) Handbook

To request a free printed copy of the Member Handbook, please call Customer Service at 1-800-440-1561 (TTY: 711), from 8 a.m. to 5 p.m., Monday through Friday. We will send you a copy within 5 business days of your request.

When you enroll in CHPW you will be sent an ID card. Your member ID card lets your provider know to bill CHPW for health care services you receive. Each person in your family who enrolls with CHPW will get two ID cards:

• CHPW Member ID card
• ProviderOne services card from the state (Health Care Authority (HCA))

You will need to show your CHPW Member ID card and your ProviderOne services card each time you get health care. That includes medical visits, specialist visits, mental health visits, hospital visits, and when you’re ordering or filling prescriptions.

If you need a new CHPW member ID card, you can view, download, and print your CHPW Member ID card online through your myCHPW member portal. You can also call CHPW Customer Service Monday through Friday, 8 a.m. to 5 p.m.

If you lose your ProviderOne services card, please call Washington State HCA’s Apple Health Customer Service at 1-800-562-3022 and follow the prompts to request a new card. Or you can submit your request online using the HCA’s Apple Health contact form with the topic “Services Card” selected.

If you need health care and don’t have your ProviderOne services card, go see your provider. They may be able to verify that you are enrolled in Apple Health with your name and date of birth.

In the state of Washington, medical necessity is used to describe care that is reasonable, necessary, and/or appropriate based on evidence-based clinical standards of care.

Other states may use different definitions of medical necessity. To find out whether a particular treatment meets the standard of medical necessity, talk to your CHPW network doctor or care provider.