Changes to continuous eligibility for kids under age six

Washington State Health Care Authority sent this bulletin at 08/03/2023 11:30 AM PDT

August 2, 2023

Changes to continuous eligibility for kids under age six

In April 2023, the Centers for Medicare & Medicaid Services (CMS) approved Washington's 1115 Waiver request to extend continuous eligibility for any child under six who is enrolled in a free Apple Health (Medicaid) program.

Children under the age of six on free Apple Health will now receive continuous eligibility through their sixth birthday, regardless of changes in household income, if they were eligible in the month of application.

Note: There have been no changes to continuous eligibility for kids over age six on free Apple Health or for those on Apple Health for Kids with premiums, also known as Children Health Insurance Program (CHIP). Coverage for these groups continues to be renewed for 12 months at a time.

What is being done to keep kids covered?

In June 2023, the Health Care Authority (HCA) began work to maintain continuous eligibility for children under the age of six. A manual process is in place to identify eligible children who have lost coverage and reinstate them.

Once the system supports continuous eligibility for kids under age six, children who are active on free Apple Health Kids and meet the eligibility criteria will have their certification period automatically extended through the month they turn six.

How can I help clients stay covered?

Providers do not need to take any action on behalf of clients. Continue to address eligibility issues per existing processes while HCA works to reinstate eligible children who have lost coverage.

Learn more

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.