While noncitizens are not eligible to access health coverage funded by the federal government, Washington State has implemented some coverage programs that are available to all residents regardless of immigration status. Eligibility for coverage programs differs based on individual program criteria.
The Migration Policy Institute estimates that there are 246,000 undocumented individuals currently living in Washington, many of whom could be eligible for one of these programs.
Coverage Options
Apple Health Expansion Program
The state legislature recently approved funding for a Medicaid/Apple Health-like program called Apple Health Expansion (AHE) for adults aged 19 or older earning up to138% of the federal poverty level (FPL), regardless of immigration status.
On July 1, 2024, when the program goes into effect, the Health Care Authority (HCA) estimates that around 13,000 eligible individuals will be able to enroll in AHE. The benefits will be managed by 4 of 5 Medicaid managed care organizations (MCOs). Enrollment for the program is capped based on available funding, there will be an estimated 13,000 individuals able to obtain coverage.
The program will mirror many benefits offered under Apple Health’s Integrated Managed Care program. However, there are key differences:
- Long Term Care services are not included in the AHE program.
- Interpreter services will be implemented differently than the traditional Apple Health program. For AHE enrollees, interpreter services will be provided via vendors directly contracted with the enrollee’s managed care organization, not through Universal Language Services.
- Drug formularies vary between Apple Health Expansion and Apple Health Integrated Managed Care/Apple Health for Foster Children.
Alien Emergency Medical (AEM) Programs
AEM programs are available to individuals who do not meet citizenship or immigration requirements that would otherwise qualify them for coverage under the state Apple Health (Medicaid) program. AEM programs are for emergent care accessed in and provided for an emergent situation in the hospital setting, kidney dialysis, cancer treatment, COVID-19 related care or care in a nursing facility. Eligible individuals must:
- Have a qualifying medical condition;
- Be aged 19-64;
- Not be receiving coverage via the Medicare program;
- Not be seeking long-term care services; and
- Follows MAGI rules established through the Healthplanfinder.
After-Pregnancy Coverage
Pregnant or postpartum individuals are eligible for after-pregnancy coverage regardless of immigration status for up to 12 months after a pregnancy ends. Eligible individuals must have a monthly household income of under 198% of the FPL and must be a Washington state resident.
Apple Health for Kids
Apple Health for Kids provides full medical and dental coverage for children up to age 19 who are Washington state residents and whose families household income is up to 317% of the FPL, regardless of immigration status.
As of June 2023, HCA is required to provide continuous eligibility regardless of changes in household income for eligible children up to age 6.
Individual Market Coverage through Washington Healthplanfinder
Effective for coverage starting January 2024, undocumented individuals are eligible to purchase insurance through Washington Healthplanfinder with the Cascade Care full-coverage option. The state legislature has also invested state funds so that all Washingtonians, regardless of immigration status, can receive Cascade Care Savings subsidies to reduce their monthly premiums.
Charity Care
Pursuant to the Washington State Charity Care law, hospitals are required to provide free and discounted inpatient and outpatient care. Each hospital is responsible for maintaining its own charity care program. Under the law, hospitals are required to help low-income patients, regardless of immigration status, cover their medical bills through the program.
Tools/Resources
Please visit the resources below to find out more about coverage options available to undocumented individuals, and for information to share with patients:
- WSHA Article (July, 2023) Health Insurance Expansions and Alien Emergency Medical (AEM) Program
- WSHA Article (May, 2024) Apple Health Expansion Applications for Non-Citizens to Open in June
- WSHA Page Charity Care and Financial Assistance at Washington State Hospitals
- Health Care Authority: Apple Health Expansion Enrollment Limit Met (6/21/2024)
- Health Care Authority: Apply for or Renew (Apple Health) Coverage Webpage
- Health Care Authority: Noncitizens Webpage
- State Department of Social and Health Services: Alien Emergency Medical Programs Webpage
- Health Care Authority: Apple Health Alien Emergency Medical Webpage
- Health Care Authority: After-Pregnancy Coverage Webpage
- Health Care Authority: After-Pregnancy Coverage (APC) One Pager
- Health Care Authority: Children Webpage
- Apple Health for Kids Continuous Eligibility One Pager
- Washington Healthplanfinder: Immigrants Webpage
- Washington Healthplanfinder: Health Care Options for Immigrants
- Molina Apple Health Expansion FAQ
- Molina Healthcare Lunch & Learn: AHE June 2024
(Updated July 2, 2024)
