Who is in Charge of Your Apple Health Healthcare?

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:

  1. 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.

  1. 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.
  2. 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:

Amerigroup (AMG)1-800-600-4441
Community Health Plan of Washington (CHPW)1-800-440-1561
Coordinated Care of Washington (CCW)1-877-644-4613
Molina Healthcare of Washington, Inc. (MHW)1-800-869-7165
UnitedHealthcare Community Plan (UHC)1-877-542-8997

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:

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.

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