One of the few silver linings of our bleak public health reality throughout the COVID-19 pandemic is that child health insurance coverage under Medicaid and the Children’s Health Insurance Program (CHIP) is at an all-time high. Due to temporary protections against Medicaid disenrollment, about 41 million children are insured through Medicaid or CHIP as of August 2022–greater than the population of California.
The long-term benefits of Medicaid enrollment on the health and wellbeing of children–particularly young children between the ages of 0 and 3–are well documented. Medicaid covers half of all babies born in the United States, which is 40 percent of all children. Study after study has shown that childhood Medicaid coverage is associated with long-lasting benefits to overall health, educational attainment, and financial stability.
However, temporary continuous coverage protections originally implemented as part of the COVID-19 pandemic response will end on March 31, 2023. This means that states will resume normal Medicaid renewal processes for all enrollees. Specifically, states will disenroll people who don’t complete the process or are newly ineligible for coverage. Policy advocates estimate that more than 6.7 million children are at risk of losing coverage if there is not a collective effort to ensure that all eligible children remain enrolled in Medicaid. State administrators, service providers, advocates, and parents/caregivers must all take proactive steps to ensure that children are not improperly disenrolled from Medicaid when states begin the massive administrative undertaking of restarting the re-enrollment process in the coming months.
The Health Care Authority (HCA) needs you! In preparation for the end of the public health emergency (PHE), we are looking for volunteers to share Apple Health (Medicaid) information with their community. Let’s help keep Washingtonians covered!
Many times, people from our community have difficulties accessing Apple Health programs and services due to language barriers, transportation, lack of engagement, etc. We are looking for volunteers from organizations such as schools, food banks, churches, and community advocates to get involved and become an Apple Health Ambassador.
HCA will continue to share updates as new information becomes available. Follow us on social media for updates on Apple Health. For more information about the Public Health Emergency visit hca.wa.gov/phe.
For families who have children with complex health care needs, coordinating all the appointments, medications, and therapies can be difficult. When an individual has several doctors and specialists that they regularly see, the help of a care coordinator can be invaluable. A care coordinator, or patient care coordinator, is a health professional employed by an MCO, or managed care organization, to oversee complex care cases. They can help with getting needed appointments, acquiring resources outside of prescriptions, ensuring that medications are easily available and do not have any interactions, and help families have better peace of mind that all of their medical practitioners are on the same page.
Care coordinators are available to many patients, but they are rarely given as an option to overtaxed patients or patients’ parents. Primary care physicians sometimes recommend a care coordinator to help a patient or family, but as they are not familiar with every aspect of a patient’s life and health care, they will often assume that a family does not need a care coordinator when they would be greatly aided by having one. For those with a strong connection to a primary provider, asking them to request a care coordinator for their healthcare can be an efficient way to start the process. While a primary care physician is often the one to initiate the assistance of a care coordinator, is possible for a patient or their family to request care coordination on their own.
The process for requesting a care coordinator is different through different health care systems. The majority of individuals on Medicaid, also known as Apple Health, have their healthcare covered by an MCO. Calling the MCO’s customer service line is often the first step in getting a care coordinator. The phone numbers of the five MCO’s that oversee apple health in Washington state are as follows: Amerigroup at 1-800-600-4441, Community Health Plan of Washington at 1-800-440-1561, Coordinated Care of Washington at 1-877-644-4613, Molina Healthcare of Washington at 1-800-869-7165, and UnitedHealthcare Community Plan at 1-877-542-8997. If you are unsure which MCO is in charge of your healthcare, view our video on Who is in Charge of Your Apple Health Healthcare? If there are problems in getting through to your MCO, you can call the Health Care Authority, that oversees all Washington Medicaid MCOs, at 1-800-562-3022.
For individuals enrolled In Washington State Medicaid, also known as Apple Health, understanding who manages their medical care is not always easy. In almost all cases, the management of care for people with Apple Health is delegated to an MCO, or Managed Care Organization. These are large for-profit organizations that often have a large infrastructure, making it confusing and difficult to find information or direction.
There are five MCO’s under Apple Health in Washington. They are Amerigroup Washington, Community Health Plan of Washington, Coordinated Care of Washington, Molina Healthcare of Washington, and UnitedHealthcare Community Plan. All of these MCOs are available statewide, except UnitedHealthcare Community Plan, with is only available in the western half of the State. For anyone in the foster care system, they are automatically enrolled in Coordinated Care of Washington and this coverage will follow them until they are 21. Health Care Authority has a Service Area Matrix to view what MCOs are available in each county.
Under some circumstances a person on Apple Health will not be put into an MCO. If an individual is American Indian/Alaska Native they can view their options on the Health Care Authority’s American Indians and Alaska Natives page. Other non-MCO Apple Health patients will have a distinct services card that looks the card shown:
For those patients, review the Health Care Authority’s Handbook on Coverage Without a Managed Care Plan for information about how to receive services. It is also possible to call them at 1-800-562-3022.
For those who do not remember which MCO they or their children are signed up with, it might have been done automatically for them when the initial roll out happened in 2014 or when they first became eligible for Apple Health under the ACA. The switch to managed care was fully implemented in 2020. Here are three ways in which to find out which MCO is overseeing an individual’s care:
Review your Provider One Card to see which MCO is listed. Individuals who are on MCO-managed Apple Health will have the name and/or logo of the MCO on the Provider One card, like the example
In this case, UnitedHealthcare is the MCO. The PCP listed is the Primary Care Physician, or a patient’s main doctor, and the PCP phone number listed can be called to schedule visits and ask medical-related questions.
If the provider card is missing, call: 1-800-562-3022 and choose option 1 for self-service, then option 1 for services card. They can help replace the provider card and help enrollees get the services they require.
Call the Health Care Authority Customer Service Line at 1-800-562-3022.
It is important to note that everyone enrolled in Apple Health within one household must be on the same managed care plan. Provider One cards are usually sent out once a year to enrollees and there is a number on the card to call for customer service. Below is the Apple Health managed care plan contact information:
All Apple Health enrollees have the right to change their MCO at any time, with no fee and with no gap in coverage. The shift usually occurs by the 15 of the following month, but the Provider One portal can help if there are challenges. There are several ways to switch plans:
Call the Health Care Authority at 1-800-562-3022 (TRS: 711).
If considering changing to a different MCO, visiting other MCOs websites or calling their information line with some questions can be useful. It is helpful to see what hospitals, urgent care facilities, specialists, and therapists are covered. Not all physicians or medical facilities that take Apple Health are contracted with all MCOs.
The Consolidated Appropriations Act, 2021, (Sec. 208) restored Apple Health (Medicaid) to Washington residents from the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia. This means that Compact of Free Association (COFA) islanders can apply for free or low-cost coverage at any time throughout the year. View the Apple Health eligibility requirements to learn more and submit your Apple Health application today!
Apply for Apple Health!
Oupwe apli ngeni ewe Apple Health! – Chuukese
Apply nuh ke Apple Health! – Kosraean
apply nan Apple Health! – Marshallese
apply a keikak er a Apple Health! – Palauan
kak kapidolong aplikeisin ong sawas en Apple Health! – Pohnpeian
Mfal’eg babyorem ko Apple Health! – Yapese
How to apply for Apple Health
Adults, children, parents/caretakers, or pregnant individuals, apply for Apple Health coverage: