Apple Health (Medicaid) and Health Benefit Exchange Changes: What you need to know
In July 2025, the U.S. Congress passed the Budget Reconciliation Bill (H.R.1), which included significant changes to Medicaid and the Affordable Care Act (ACA). In Washington state, these changes may affect your eligibility, enrollment and renewal requirements for healthcare insurance under Apple Health or Washington Health Benefit Exchange.
If your current Apple Health coverage is changing, you will receive notifications from either the Washington Health Care Authority (HCA) or the Washington State Department of Social and Health Services (DSHS). For the Washington Health Benefit Exchange changes, details will be provided closer to the start of open enrollment.
For more information, please refer to the following timelines, frequently asked questions and resources.
What’s Changing
- Apple Health
- Oct. 1, 2026: Changes in eligibility for noncitizens/immigrants.
- Jan. 1, 2027: New work requirements, coverage period changes, revised retroactive eligibility rules and new verification requirements.
- Oct. 1, 2028: New cost-sharing requirements.
- Washington Health Benefit Exchange
- Jan. 1, 2027: Changes in premium tax credits.
- Certain low-income lawfully present immigrants will no longer qualify for premium tax credits.
- Individuals denied Medicaid for not meeting the work requirements will not be eligible for premium tax credits.
- Jan. 1, 2027: Changes in premium tax credits.
Timeline for Upcoming Changes
Apple Health Changes
When | What Changes | What to Expect | What Action to Take |
|---|---|---|---|
Mid-July 2026 | Noncitizen/immigrant eligibility | First notice from HCA or DSHS. | Review your notice and reply as directed if you have questions. |
Mid-August 2026 | Noncitizen/immigrant eligibility | Second notice from HCA or DSHS with a Sept. 30, 2026, coverage end date. | Explore other coverage options and reply as directed for assistance if needed. |
July – December 2026 | Noncitizen/immigrant eligibility | You may be contacted by Washington Healthplanfinder or UW Medicine navigator to help you understand your options. | Respond promptly and explore other coverage options. |
Sept. 30, 2026 | Noncitizen/immigrant eligibility | Coverage may end. | Enroll in other coverage if eligible and seek assistance if needed. |
Jan. 1, 2027 | Work Requirements | Some Apple Health for Adults members must work, participate in training or complete community engagement activities for at least 80 hours per month (some exceptions apply). | Learn whether the requirement applies to you and be prepared to report qualifying activities. |
Jan. 1, 2027 | More frequent coverage renewals | Apple Health for Adults coverage must be renewed every 6 months instead of every 12 months. | Watch for renewal notices and respond on time to avoid losing coverage. |
Jan. 1, 2027 | Retroactive Coverage | Retroactive coverage is reduced from 3 months to 1 month for Apple Health for Adults and 2 months for most other Apple Health programs. | Apply early and complete renewals on time to avoid gaps in coverage. |
Jan. 1, 2027 | Verification Requirements | Increased verification requirements, including death and address checks. | Check this webpage and the Resources section for updates. |
Oct. 1, 2028 | Cost-Sharing | Some members may pay small copays (up to $35) for certain services. | Check this webpage and the Resources section for updates. |
Washington Health Benefit Exchange Changes
When | What Changes | What to Expect | What Action to Take |
|---|---|---|---|
Nov. 1, 2026 – Jan. 15, 2027 (Open Enrollment) | Premium Tax Credits | New eligibility rules may affect your plan options or financial assistance. | Review your options during open enrollment and request help if needed. |
Frequently Asked Questions
Medicaid and Affordable Care Act (ACA) Changes Overview
What changes are happening that may impact my Medicaid (Apple Health) and ACA (Washington Health Benefit Exchange) coverage?
In July 2025, the U.S. Congress passed the Budget Reconciliation Bill (H.R.1), which included significant changes to Medicaid and the Affordable Care Act (ACA). In Washington state, these changes may affect your eligibility, enrollment and renewal requirements for healthcare insurance under Apple Health or Washington Health Benefit Exchange.
The changes will be implemented in phases over the next several years.
For Washington state, who is implementing these changes?
Each state is required to implement these changes according to timelines established by the federal law. In Washington state, the plans with changing requirements are administered by the following agencies:
- Washington Health Care Authority (HCA) manages Washington Apple Health (Medicaid) for clients ages 19-64.
- Washington State Department of Social and Health Services (DSHS) manages classic Apple Health (Medicaid) for clients ages 65 and over including people who are blind or disabled.
- Washington Health Benefit Exchange manages the WA Healthplanfinder tool to screen for Medicaid and Affordable Care Act coverage options.
What should I do if I am enrolled in an Apple Health or Washington Health Benefit Exchange plan?
Keep your information up to date! Make sure your phone number, email and mailing address are correct to get important updates about changes to your coverage. Be sure to read and respond promptly to all notifications to prevent a gap in your coverage. If applicable, make sure your immigration status is up to date as it may offer you more coverage options.
Learn how to update your information at hca.wa.gov/report-a-change.
What is UW Medicine’s role?
UW Medicine is helping our patients navigate these changes by providing awareness, connecting you to tools and resources, and answering your questions.
Financial counselors are available at Harborview Medical Center, University of Washington Medical Center – Montlake and University of Washington Medical Center – Northwest. To schedule an appointment, call 206.744.3084.
What happens if I lose my Apple Health coverage because of the new requirements?
If you are no longer eligible for Apple Health, you can apply annually for other health insurance plans through Washington Healthplanfinder during open enrollment. For coverage in 2027, open enrollment begins on Nov. 1, 2026, and ends on Jan. 15, 2027.
If you lose your Apple Health coverage, you may also be able to enroll in a Washington Health Benefit Exchange plan during a special enrollment period outside of open enrollment. To apply for special enrollment, visit Washington Healthplanfinder or call Washington Healthplanfinder Customer Support Center at 1.855.923.4633.
What are my options for the Washington Health Benefit Exchange?
If you are no longer eligible for Apple Health, you can apply annually for other health insurance plans through Washington Healthplanfinder during open enrollment. For coverage in 2027, open enrollment begins on Nov. 1, 2026, and ends on Jan. 15, 2027.
If you lose your Apple Health coverage, you may also be able to enroll in a Washington Health Benefit Exchange plan during a special enrollment period outside of open enrollment. To apply for special enrollment, visit Washington Healthplanfinder or call Washington Healthplanfinder Customer Support Center at 1.855.923.4633.
Oct. 1, 2026: Noncitizen/Immigrant Apple Health Changes
What is changing for noncitizens/immigrants?
Currently, some noncitizens can enroll in Medicaid as “qualified immigrants.” The federal definition of “qualified immigrant” will change, limiting eligibility for Medicaid, starting in October 2026.
Effective October 1, 2026, Apple Health will be limited to the following statuses:
- U.S. citizens and nationals
- Lawful permanent residents who have met or are exempt from the 5-year bar
- Compact of Free Association (COFA) islanders
- Cuban/Haitian entrants
- Children, pregnant individuals and individuals within 12 months postpartum continue to be eligible for Apple Health regardless of immigration status if they meet all other requirements
Effective Sept. 30, 2026, individuals with an immigration status indicated below will no longer be eligible for Apple Health:
- Asylees
- Conditional entrants
- Refugees
- Individuals for whom deportation or removal has been withheld
- Victims of trafficking
- Violence Against Women Act (VAWA) self-petitioners
- Parolees, including:
- Individuals paroled as part of the Afghan Allies Protection Act of 2006.
- Afghans granted humanitarian parole between July 31, 2021, and Sept. 30, 2023.
- Ukrainians granted humanitarian parole between Feb. 24, 2022, and Sept. 30, 2024.
The following immigration categories are exempt from the 5-year bar when they adjust their status to lawful permanent resident (LPR). Federal law requires many qualified immigrants to wait five years before becoming eligible for Medicaid. This waiting period is commonly referred to as the 5-year bar and usually begins when the individual receives their qualifying immigration status, not when they entered the U.S. It is important to update your status to maximize your coverage options.
- Asylee
- Amerasian
- Cuban/Haitian
- Refugee
- Victims of trafficking
- Immigrants from Iraq or Afghanistan granted the following:
- Special immigrant status
- Special immigrant conditional permanent resident
For more information, go to the Noncitizen Fact Sheet below in Resources.
How will I know if the noncitizens/immigrants changes apply to me?
You will receive your first notice that these changes may affect your coverage in mid-July 2026 from either HCA or DSHS. In mid-Aug 2026, you will receive a second notice, which will include a coverage termination for Sept. 30, 2026.
What should I do if I receive a letter from HCA or DSHS?
Read it carefully. If it asks for information or documents, respond within 30 days. Call the number on the letter if you are not sure what to do. Do not ignore it.
UW Medicine can help you identify what other options are available.
How many noncitizens/immigrants may lose their coverage? Are there any exemptions?
In Washington state, approximately 14,000 residents may lose their current coverage beginning Oct. 1, 2026. Other options may be available, and the following programs remain open regardless of immigration status:
- Apple Health for Pregnant individuals
- After Pregnancy coverage (APC)
- Apple Health for Kids
- Emergency Medical (AEM)
- Apple Health Expansion (AHE)*
* Apple Health Expansion has enrollment restrictions and is currently at full capacity. Enrollment opportunities will depend on space and funding availability.
For more information about these programs, visit Noncitizens | Washington State Health Care Authority.
What are my options to find other coverage?
All Washingtonians, regardless of immigration status, can shop for and buy qualified health and dental plans through Washington Healthplanfinder.
For more information, go to the Noncitizen Fact Sheet below in Resources.
Jan. 1, 2027: Apple Health Work Requirements, Coverage Periods and Retroactive Eligibility
Can you help me understand these changes?
In Washington state, approximately 600,000 residents are enrolled in Apple Health for Adults. HCA is working to determine the percentage of this population expected to be verified or exempt using current and available data sources. The goal is to automatically renew coverage of individuals who meet these exemptions and not require them to prove their eligibility through manual processes. For those needing to provide proof of work, clients will need to prove they meet requirements one month prior to their renewal date.
Most individuals applying for or renewing Apple Health for Adults (ages 19-64) will have new requirements:
Work Requirements
Work requirements are met when an individual:
- Has at least $580 in monthly household income (or an average monthly income of $580 over a 6-month period for seasonal workers).
- Enrolls in an educational program at least half-time.
- Participates in a work program at least 80 hours per month.
- Completes at least 80 hours of community service per month.
- Has a combination of hours of work, community service, work program, or educational program totaling at least 80 hours per month.
Coverage Periods
Apple Health for Adults coverage periods will change from 12 months to 6 months beginning Jan. 1, 2027. The change will occur at your first renewal in 2027. For example, if your application for coverage through Washington Healthplanfinder is approved for Apple Health for Adults on February 1, 2027, your certification period will end on July 31, 2027 (6 months) instead of January 31, 2028 (12 months).
Verifications
Increased verification requirements will include death and address checks.
Learn how to renew your coverage: Apply for or renew coverage | Washington State Health Care Authority.
Are there any exemptions to the work requirement?
Yes. Work requirements only apply to Apple Health for Adults. Work requirements or an exemption must be met in the month before applying or in any of the six months before renewing coverage.
- Certain individuals eligible for Apple Health for Adults are exempt from work requirements. For more information, go to Work Requirements and Renewals Fact Sheet below in Resources.
- Work requirements do not apply to other Apple Health programs, including children, pregnancy services or long-term care services.
- American Indian and Alaska Native (AI/AN) individuals are exempt from the work requirement.
How will the work requirements be submitted?
Clients will continue to enroll and verify eligibility through the Washington Healthplanfinder. To support work requirement verification and exemptions, the state is developing a new verification hub, which will expand automated verification capabilities while limiting manual processes and impacts to current eligibility systems. The new verification hub is expected to be available by January 2027.
Are there any exemptions to the coverage periods requirement?
Coverage periods requirements only apply to Apple Health for Adults. They do not apply to any other Apple Health program, including children, pregnancy services or long-term care services. American Indian and Alaska Native (AI/AN) individuals are exempted from the shortened six-month renewal periods.
Can you help me understand the retroactive coverage change? Are there any exemptions?
Retroactive coverage period reductions will apply to every Apple Health program. The process for requesting retroactive coverage remains unchanged, and there are no exemptions to this change.
- Apple Health for Adults (ages 19-64): Retroactive coverage starts one month before the application is filed.
- Other Apple Health Programs: Retroactive coverage starts two months before the application is filed. This includes individuals who apply for Apple Health through Washington Connection.
For example, individuals applying for Apple Health in January 2027 may receive retroactive coverage for the month of:
- December 2026 when enrolled in Apple Health for Adults.
- November and December 2026 for all other Apple Health programs.
For more information, go to the Retroactive Coverage Fact Sheet below in Resources.
Oct. 1, 2028: Cost Sharing Apple Health
Will I have to pay for Apple Health?
Most people will not have to pay. Starting October 2028, some members may have a small cost for certain visits — up to $35. More details will be provided closer to October 2028.
Affordable Care Act/Washington Health Benefit Exchange
What do I need to know about changes to Exchange plans during the next open enrollment?
There are two changes involving premium tax credits:
- Loss of Tax Credit eligibility for low-income lawfully present immigrants. Federal subsidies are eliminated for many lawfully present immigrants regardless of income or tax filing status.
- No Tax Credit eligibility when denied Medicaid for not meeting work requirements. People who are denied Medicaid eligibility due to work requirements not being met will also be denied federal subsidies for qualified health plans purchased through the Washington Health Benefit Exchange.
Open enrollment begins Nov. 1, 2026, for plan year 2027. More details will be provided closer to the start of open enrollment.
Resources
Visit the following Health Care Authority (HCA) resources to learn more about upcoming Apple Health (Medicaid) changes:
- Apple Health Eligibility Fact Sheet: Provides a brief overview of upcoming eligibility changes.
- Enrollment Assistance Fact Sheet: Explains the different ways you can get help with enrollment and coverage.