Medicaid agency: HCA
Washington Medicaid, branded Apple Health, is administered by the Health Care Authority (HCA), with the Department of Social and Health Services (DSHS) handling eligibility, case management, and long-term services and supports for aged, blind, and disabled coverage groups under an interagency agreement. Apple Health delivers integrated managed care (physical health, mental health, and substance use disorder treatment under one plan) across 10 regions statewide, through five MCOs: Molina Healthcare of Washington, Community Health Plan of Washington, Coordinated Care, UnitedHealthcare Community Plan, and Wellpoint Washington, still listed under its former name, Amerigroup, in CMS's most recent enrollment data. A single statewide plan, Apple Health Core Connections, run by Coordinated Care, covers all foster care enrollees. Washington runs several Section 1115 demonstrations alongside comprehensive managed care, including the Medicaid Transformation Project 2.0, which funds health-related social needs services, a reentry initiative for incarcerated individuals nearing release, and continuous eligibility for young children. Apple Health Expansion, the state's coverage program for adults who don't qualify for other Apple Health programs based on immigration status, has had enrollment closed since December 2025 because of H.R. 1's anticipated fiscal impact; current enrollees keep coverage until January 1, 2027, when the program shifts from managed care to fee-for-service, and the state is designing a more limited replacement benefit for a broader group affected by H.R. 1 and DACA-related coverage losses. Washington has joined the multistate lawsuit challenging the CMS rule implementing the federal work-requirements mandate, which remains in effect after a preliminary injunction was denied.
Apple Health's comprehensive managed care program, per CMS's 2024 managed care enrollment data, is delivered by five MCOs: Molina Healthcare of Washington (837,457 members), Community Health Plan of Washington (252,143), Coordinated Care of Washington (196,657), UnitedHealthcare (208,078), and Amerigroup (166,570), a combined 1.66 million enrollees. Not every plan operates in every region; plan participation varies across the state's 10 integrated managed care regions.
Long-term services and supports run separately from Apple Health's five managed care plans. DSHS's Home and Community Living Administration (HCLA) administers HCBS through fee-for-service Section 1915(c) waivers billed directly to ProviderOne, including COPES (the largest, serving elderly and disabled members at risk of nursing home placement), Basic Plus, Core, New Freedom, Residential Support, Community Protection, Individual and Family Services, and Children's Intensive In-Home Behavioral Support.
Not integrated into managed care
Behavioral health is integrated into Apple Health's five managed care plans alongside physical health, not carved out to a separate vendor. Clients who qualify for Apple Health but not for full managed care enrollment (because they are dual-eligible, enrolled in Apple Health Medicare Connect, Medically Needy, or have met a spenddown) get behavioral health coverage instead through a Behavioral Health Services Only (BHSO) plan, offered by the same five health plans. Regional Behavioral Health Administrative Services Organizations (BH-ASOs), funded through state and federal block grants, separately run 24/7 crisis lines, mobile crisis outreach, and involuntary treatment act evaluations for the broader population, including people not enrolled in Apple Health.
Carved in
Dental care for both children and adults is covered directly by Apple Health on a fee-for-service basis, billed through ProviderOne, with no dedicated dental administrator. DentistLink is a referral tool that helps clients find a dental provider; it does not administer claims.
Pharmacy is carved into Apple Health's managed care plans rather than routed through a separate PBM. All managed care plans and the fee-for-service program use the same Apple Health Preferred Drug List (PDL), with the same prior authorization criteria, step therapy edits, and quantity limits set by HCA.
Non-emergency medical transportation is arranged through regional brokers assigned by county rather than a single statewide vendor: Hopelink covers King and Snohomish counties, Special Mobility Services covers much of eastern Washington, and Paratransit Services covers several Puget Sound-area counties.
ProviderOne is Washington's Medicaid Management Information System. Acentra Health currently operates ProviderOne's HIPAA EDI processing function. HCA has not published a current MMIS contract term or renewal date.
219 agency updates tracked for Washington. Available with Pro.
See them with ProWashington's Department of Social and Health Services has proposed restricting eligibility for developmental disability services as part of its budget request for the state's next two-year spending plan, aiming to save $13.3 million, including about $6 million in general fund savings. The change would raise the bar for qualifying activities-of-daily-living support, ending Medicaid eligibility for an estimated 2,655 residents and potentially eliminating housing for people in residential facilities whose placement depends on eligibility. Advocates, including The Arc of Washington State, warn the cuts could push people into costlier institutional or hospital settings and homelessness. The proposal now goes to Gov. Bob Ferguson, who will release his budget plan in December ahead of a multibillion-dollar shortfall lawmakers face when the legislature reconvenes in January; the budget would run July 2027 through June 2029.
At a Walla Walla candidate forum, Republican incumbent Rep. Michael Baumgartner and Democratic challenger Carmela Conroy debated the Medicaid and health coverage effects of the One Big Beautiful Bill Act ahead of Washington's 5th Congressional District race. Baumgartner defended the law's Medicaid work requirements and its disincentives for states covering undocumented immigrants, citing $50 billion in new rural health funding including $181 million for Washington in fiscal year 2026. Conroy countered that legal immigrants, including workers and students, are losing coverage under the law and said she would push to expand Medicaid access for people from birth to age 19. The forum comes as roughly 10,000 legal immigrants in Washington have already lost Medicaid coverage this month under the act, with a federal court temporarily blocking further losses for about 800 more.
A federal provision in the 2025 tax and spending law stripped Medicaid eligibility for refugees, asylees, trafficking survivors, and other lawfully present immigrants nationwide, cutting roughly 10,000 people in Washington from coverage as of Thursday. A U.S. District Court judge in Seattle issued a preliminary ruling preserving coverage for an estimated 800 of those immigrants who receive Supplemental Security Income, finding federal officials improperly tried to override existing eligibility rules; the government may appeal. State officials separately updated immigration records to save coverage for about 3,000 more people, reducing original loss projections from 14,000. Washington's governor has issued an executive order to track coverage losses and explore state funding options, while advocates push for state dollars to cover the gap.
MultiCare Health System, a 13-hospital nonprofit system based in Tacoma, Wash., announced on Oct. 1 the launch of MultiCare Health Plan, a wholly owned subsidiary. Its first product will be a Medicare Advantage HMO with drug benefits, available for the 2027 plan year in three Washington counties, supported by independent physician association Physicians of Southwest Washington. Karen Decaran-Voigt, a longtime payer and provider executive with prior roles at Molina, UnitedHealth, CommonSpirit and Elevance, will lead the new plan. The move comes as MultiCare pursues an affiliation with Samaritan Health Services, whose own health plan continues to offer Medicaid and D-SNP products, and runs counter to a broader trend of health systems shutting down their own insurance plans amid rising costs.
Roughly 14,000 Washington state residents, refugees, humanitarian asylees, trafficking survivors, and other lawfully present immigrants without green cards, lose Apple Health (Medicaid) eligibility starting Oct. 1, under the federal law known as HR1. Washington State Health Care Authority Director Ryan Moran warns the change will strain hospitals as affected individuals lose coverage and increasingly rely on emergency departments for care. The same law also bars these immigrants from buying subsidized marketplace plans in 2027, and unsubsidized plans are expected to be unaffordable, meaning most will likely become uninsured. KUOW/Northwest News Network reports the state expects broader downstream effects on the health care system beyond the individuals directly losing coverage.
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