Washington Medicaid Under H.R. 1: Preparing for Apple Health Coverage Changes
Washington Gov. Bob Ferguson signed an executive order to mitigate the effects of federal H.R. 1 on Apple Health coverage, as the state prepares for significant Medicaid changes under the federal legislation passed last summer. The governor announced the order at a press conference last week with many healthcare and patient advocacy leaders joining him at the podium, including John Scott, MD (pictured in back), from WSMA’s executive committee.
Beginning Oct. 1, 2026, eligibility restrictions will affect certain lawfully present noncitizen adults. In its announcement, the governor’s office says that outreach has preserved Apple Health coverage for 3,000 immigrants, but approximately 11,000 may still lose coverage.
Beginning Jan. 1, 2027, adults enrolled in Apple Health for Adults will generally need to document 80 hours per month of work, education, training, or community engagement-or qualify for an exemption. Renewals will also shift from annually to every six months. These requirements apply specifically to Apple Health for Adults, not programs such as children’s or pregnancy coverage.
Washington is developing an automated verification system intended to reduce administrative barriers and help approximately 400,000 people maintain coverage. The governor’s executive order also establishes an H.R. 1 Medicaid response committee, statewide outreach efforts, and data systems to monitor coverage disruptions and health-system impacts.
Despite these efforts, the state projects at least 200,000 Washingtonians could lose Apple Health coverage by the end of 2027 as a result of H.R. 1.
Physicians should anticipate potential insurance interruptions, increased administrative needs, and delayed or disrupted access to care among Medicaid patients. Clinicians can help by encouraging patients to keep contact information current, respond promptly to Apple Health notices, and seek assistance with renewals or exemptions when appropriate. Use the following resources to help:
- H.R. 1 provider toolkit from the Health Care Authority provides details on Medicaid eligibility changes and options for keeping patients covered.
- The Health Care Authority adopted a diagnosis code list and methodology to help identify diagnoses that likely impact an individual’s ability to work. For context, review this guidance memo to physicians and healthcare professionals.
- A new CMS requirement will result in off-cycle revalidation for some Medicaid providers. See this FAQ on off-cycle provider revalidation.