Wa State Medicaid Income Limits

How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In Washington

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare including long-term care.

Our guide to financial assistance for Medicare enrollees in Washington includes overviews of these programs, including Medicaid long-term care benefits, Extra Help, and eligibility guidelines for assistance.

Washington Medicaid Income Limit Charts

The Washington Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Washington who qualify for Medicaid.

Washington Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

How to Read the Washington Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 193% of the Federal Poverty Level which for a family of two is $33,621 as shown in the chart above.

Who Can Get Medicaid In Washington

You should apply for Medicaid if your income is low and you match one of the descriptions below:

• You think you are pregnant
• The parent or caretaker of a child and/or teenager under the age of 19.
• You are a child or teenager age 18 or under.
• An adult age 65 or older.
• You are legally blind.
• Living with a disability or disabled.
• You are in need of nursing home care.

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Withinreach Is Here To Help

Health insurance enrollment can be confusing but WithinReach is here to help. Our friendly, local, and knowledgeable staff can help you understand and apply for health insurance based on your needs and budget.

We are certified as âin-person assistersâ by the Washington State Health Benefit Exchange. Regardless of your financial situation, we are here to guide you through the system and help you understand and apply for health insurance. Visit our online Benefit Finder or call the WithinReach Help Me Grow Washington Hotline at 1-800-322-2588 today to get started. Or, read on to learn more about health insurance.

Medicaid Income Limits And Spending By State

Medicaid offers health coverage to millions of Americans, notably children, pregnant women, parents, … seniors and people with disabilities. In order to be eligible, you must meet household size and income limits.

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Medicaid spending is something that fluctuates fairly substantially from state to state. Medicaid income limits, too, vary by state, which can make it hard to know if you qualify depending on where you live. Here, well breakdown Medicaid spending by state and Medicaid income limits by state.

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Impact On Uninsured Rate

According to U.S. Census data, the uninsured rate in Washington was 14% in 2013, and had fallen to 6% by 2016 a drop of 57%. Only eight states had a higher percentage point drop in uninsured rate during that time, and Washingtons drop was far higher than the 5.9 percentage point drop across the country as a whole. Its clear that Medicaid expansion played a significant role in reducing the uninsured rate in the state.

However in 2020, the coronavirus triggered widespread job losses and subsequent losses of employer-sponsored health insurance. Washington States uninsured rate climbed to 12% as of May 2020.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Washington Has Accepted Federal Medicaid Expansion

• 1,965,401 Number of Washingtonians covered by Medicaid/CHIP as of May 2021
• 847,825 Increase in the number of Washingtonians covered by Medicaid/CHIP fall 2013 to May 2021
• 54% Reduction in the uninsured rate from 2010 to 2019
• 76% Increase in total Medicaid/CHIP enrollment in Washington since 2013

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Where Can I Apply For Medicaid In Washington

Medicaid is administered by the State Health Care Authority in Washington. You can apply online for Medicaid for Medicaid ABD or the MSP. Applicants can also call 855-242-8282 with questions about their Medicaid application.

An in-person interview is always required when applying for long-term care benefits, and many states also require one for Medicaid ABD. However, states cant require an interview if youre only applying for an MSP.

Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare technical assistance contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive. He has also held consulting roles, including at Sachs Policy Group, where he worked on Medicare and Medicaid related client projects.

Qualified Health Plans And Other Individual Insurance

Children and adults can buy Qualified Health Plans if they are US citizens or have an eligible immigration status, are state residents, and are not in jail/prison.

Children and adults can get subsidies to help with the costs of buying a Qualified Health Plan if they meet other requirements, including: having household income below 400% of the Federal Poverty Level not qualifying for public programs like Apple Health or Medicare and not having an affordable offer of coverage through a parent’s employer.

You can shop and apply for coverage at Washington Healthplanfinder. Other individual health insurance plans are available outside the QHP marketplace at full price. Learn more here.

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Washington Home And Community

Apple Health covers nursing home care for Washington residents who meet applicable financial and functional need criteria, as described above and determined by the Washington DSHS. Washington’s Medicaid program structure also recognizes, though, that individuals who qualify for nursing home coverage might prefer to live in their homes or alternate care environments, such as assisted living residences. Living outside of a nursing facility could be less expensive for the state and more convenient and desirable for the individuals, for various reasons.

Therefore, Medicaid “waiver” programs will also pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These programs can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.

The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. Thus, in 2019 an individual applicant cannot have monthly income greater than $2,313, and the applicant’s assets are limited to $2,000.

Under certain circumstances, program participants can receive assistance simultaneously under CFCO and COPES. If you are a Washington resident who needs Medicaid assistance but are unsure whether you meet the relevant income and asset limits, you can read more about eligibility and consult the Washington State Health Care Authority for more guidance.

How Do You Qualify For Free Medicare

You are eligible for premium-free Part A if you are age 65 or older and you or your spouse worked and paid Medicare taxes for at least 10 years. You can get Part A at age 65 without having to pay premiums if: You are receiving retirement benefits from Social Security or the Railroad Retirement Board.

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Who Is Eligible For Medicaid In Washington

Apple Health provides health insurance coverage for qualifying children, pregnant women, parents, seniors, and individuals with disabilities. See the Eligibility page on the Washington State Health Care Authority website for details. Below is a summary of income limits for non-elderly adults and children.

• Adults with incomes up to 138% of the federal poverty level
• Children with household incomes up to 210% of poverty
• Pregnant women with incomes up to 193% of poverty.
• Children are eligible for CHIP with household incomes up to 312% of poverty.

Apple Health for Kids is available to children even if they are undocumented immigrants. In that case, only state Medicaid funds are used to provide coverage, and families with income above 200% of the poverty level will have to pay higher premiums to cover a child who is undocumented. Pregnant undocumented immigrants are also eligible for state-funded Apple Health coverage.

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How Federal Poverty Levels Are Used To Determine Eligibility For Reduced

• Income above 400% FPL: If your income is above 400% FPL, you may now qualify for premium tax credits that lower your monthly premium for a 2022 Marketplace health insurance plan.
• Income between 100% and 400% FPL: If your income is in this range, in all states you qualify for premium tax credits that lower your monthly premium for a Marketplace health insurance plan.
• Income at or below 150% FPL: If your income falls at or below 150% FPL in your state and youâre not eligible for Medicaid or CHIP, you may qualify to enroll in or change Marketplace coverage through a Special Enrollment Period.
• Income below 138% FPL: If your income is below 138% FPL and your state has expanded Medicaid coverage, you qualify for Medicaid based only on your income.
• Income below 100% FPL: If your income falls below 100% FPL, you probably wonât qualify for savings on a Marketplace health insurance plan or for income-based Medicaid.

The figure used to determine eligibility for premium tax credits and other savings for Marketplace health insurance plans and for Medicaid and the Children’s Health Insurance Program . MAGI is adjusted gross income plus these, if any: untaxed foreign income, non-taxable Social Security benefits, and tax-exempt interest.

Find Out If You’re Eligible For Free Health Insurance

Find out if you can get free or reduced-cost insurance both are available from Washington Healthplanfinder. To find out which program you’re eligible for, start with the Individual & Families Cost Estimate Calculator.

If eligible for Apple Health, you will need to select a Managed Care Organization. All MCOs cover Essential Health Benefits including hospitalization, prescriptions, preventative, wellness services, chronic disease management, pediatric services, maternity and newborn care. Each MCO offers Value Added Benefits in addition to your health coverage.

Apple Health is open year-round. Renewal notices are mailed 60 days before coverage expires. Renew online at Washington Healthplanfinder.

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Washington Medicaid Expansion Update

Medicaid expansion was added as a line item to the state budget , and on June 30, 2013.

Washington Governor Jay Inslee approved the budget for the upcoming fiscal year.

Eligible residents were able to begin submitting applications on October 1, 2013, with expanded Medicaid policies effective January 1, 2014.

As a result of Medicaid expansion, total enrollment in Washington Medicaid and CHIP grew by nearly 644,000 people between the fall of 2013 and November 2017.

That was an enrollment growth of 58 percent, the sixth-highest percentage increase in the nation.

As a result of Medicaid expansion, the state saw a 56% reduction in the insured rate from 2013 to 2017.

How Do You Calculate Your Medicaid Income Eligibility

Follow these steps to calculate whether or not your income may qualify you for Medicaid:

• Find the FPL for your household using the chart above
• Multiply that number by your states Medicaid income limit found below, and then divide by 100

For example, if there are two people living in your household and you live in Arizona, you would multiply $17,420 by 138 and then divide by 100. That equals $24,039.60.

You may also multiply $17,420 by 1.38.

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How Much Is The Federal Poverty Level

The federal poverty level in 2021 is equal to an income of $12,880 per year for an individual adult, plus $4,540 for each additional household member. Alaska and Hawaii have different benchmarks because of their differing costs of living.

What Is Apple Health

Apple Health is the name for Medicaid in Washington. Apple Health is free or low-cost health insurance coverage for those who qualify. Covered services include primary care, emergency visits, maternity services, pediatric care, dental services, vision care, prescription medications and more.

Apple Health is available year-round. You can apply for Apple Health at any time.

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What Are The Medicaid Requirements In Washington State

To be eligible for Washington Medicaid, you must be a resident of the state of Washington, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.

Applying For Apple Health Coverage

You have many options to apply for Apple Health coverage. Visit our Apply for or renew coverage webpage to learn more.

When youre ready to apply, youll need:

• Your household monthly income.
• The Social Security numbers and dates of birth for each member of your household.
• Your immigration information, if that applies to you.

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What Is Free Or Low

Free or low-cost coverage

Fill out your information below to find out if you may qualify for Medicaid. If you do, you may be eligible to get your Medicaid health care through Kaiser Permanente. If you dont qualify for Medicaid, you may qualify for federal financial assistance to help you afford your health care.

NOTE: The information provided is for reference only. Final eligibility is determined by WashingtonApple Healthand Washington Healthplanfinder for federal financial assistance.

Medicaid Coverage For Nursing Homes

As referenced above, Medicaid is a government health insurance program available to people with limited income and resources. If you are age 65 or older, blind, or disabled and meet income and resource requirements, Washington’s Medicaid program, called Apple Health, provides coverage for nursing home residents under certain circumstances.

To obtain Apple Health coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.

To apply for LTC Medicaid for nursing home coverage, you must submit an application to the Washington Department of Social and Health Services , either in paper or online. In general, you must meet financial requirements and require a level of care that cannot be met anywhere but in a nursing home.

Typically, your care nursing facility can assist you with the Medicaid application process or you can apply directly with the DSHS. Before you apply, make sure that to the best of your knowledge you meet the eligibility criteria.

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How Many People Are On Medicaid

According to the Centers for Medicare & Medicaid Services, as of November 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:

• 78,521,263 individuals were enrolled in Medicaid and CHIP
• 72,204,587 individuals were enrolled in Medicaid
• 6,695,834 individuals were enrolled in CHIP

Option 3 Download Application

You can an application, complete it, and mail it to your an HCS office or submit it in person.

Heres how to contact the Washington Medicaid Agency:

For Medicaid Applicant & Member Services

If you are not enrolled in an Apple Health managed care plan, or you dont know how to reach your plan, contact Apple Health Customer Service at 1-800-562-3022.

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