Changes to continuous eligibility for kids under the age of six

Washington State Health Care Authority sent this bulletin at 04/08/2025 10:00 AM PDT

April 8, 2025

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Changes to continuous eligibility for kids under the age of six

On January 8, 2025, the Centers for Medicare & Medicaid Services (CMS) approved Washington's 1115 Waiver request to extend continuous eligibility for any child under age six who is enrolled in the Apple Health for Kids with Premiums program, also known as Children Health Insurance Program (CHIP).

This change is in addition to the April 2023 waiver approval for any child under age 6 who is enrolled in a free Apple Health for Kids (Medicaid) program.

Children under the age of six on Apple Health for Kids with or without premiums will now receive continuous eligibility through their sixth birthday month, regardless of changes in household income, if they were eligible in the month of application.

Note: No changes have been made to continuous eligibility for kids over the age of six who are active on an Apple Health for Kids program. Coverage for this age group continues to be renewed for 12 months at a time through the end of the month they turn nineteen years old.

What is being done to keep kids covered?

The Health Care Authority (HCA) maintains continuous eligibility for children under age six.

As of April 2025, HCA has a manual process in place to reinstate eligible children who have lost coverage. System updates are scheduled for July 2025 to automate this process.

What steps are needed to get a child age 0-6 active if they lose coverage?

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.

If a child needs to visit a provider and coverage has not been reinstated yet, the parent or caretaker can contact HCA at 1-800-562-3022 for assistance.
If you have questions, email us at AskMAGI@hca.wa.gov.

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About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

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.