Apple Health (Medicaid) work requirements

Medicaid is a government program that pays for medical services. Washington uses the term Apple Health to refer to Medicaid programs.

Under federal law, certain people must report their work, educational, or volunteer activity (also called community engagement) starting January 1, 2027, to keep or enroll in Medicaid. 

It depends. Work requirements only apply to people in the Medicaid Expansion (Apple Health for Adults) population. You may be in this group if all these apply to you: 

• You’re 19 - 64 years old
• Your countable income is below 138% of the federal poverty level
• You’re not on Medicare Part A or B
• You’re not eligible for “classic” Medicaid (linked to Aged, Blind, or Disabled, or SSI)
• You don’t need pregnancy-related coverage
• You’re not described in any other mandatory eligibility groups, such as parent and caretaker relatives or children

Even if you’re in the Medicaid Expansion population, you may not have to meet work requirements if any of these describe you: 

• Pregnant or entitled to postpartum medical assistance
• Foster youth or former foster youth under age 26
• American Indian or Alaska Native
• Parent or caretaker of child under age 14
• Parent or caretaker of someone with a disability
• Inmate in a public institution or up to 3 months after release
• Live in a household that gets food assistance and not exempt from those work requirements
• In alcohol or substance use treatment
• Disabled veteran with 100% disability rating
• Medically frail or have special medical needs. You may be medically frail if you have one of these and it makes it hard to meet work requirements: a substance use or disabling mental disorder, a disability that makes it hard to do any daily task of living, a serious or complex medical condition, or blindness or disability. Try to talk to a lawyer if you think one of these describes you and you want help being exempted from work requirements.  
• You have a short-term hardship. This can means one of these: You must travel for care for a serious or complex medical condition for you or a dependent, you spend at least part of a month in an institutional setting (such as an inpatient hospital or a nursing home), you live in an area where the President has declared a disaster, or the unemployment rate where you live is higher than in the rest of the country.

You must either have a monthly household Modified Adjusted Gross Income of at least $580, or spend at least 80 hours a month doing one or a combination of these: 

• Working (for money, for goods and services, or unpaid)
• Going to school at a community college, vocational or technical school, or 4-year college or university
• In a work program designed to help you get a job
• Doing community service (volunteer or court-ordered)

The Washington Health Care Authority (HCA) will use information the state already has about you to check your eligibility. HCA will ask you for proof only if they don't have the information they need. 

• Keep your contact information up to date with HCA (Apple Health) and any other agencies you get benefits from.
• Mark your calendar to check your contact information every six months.
• Don’t wait to see your care providers.
• Have your prescriptions filled for as many doses as you can get. 
• In 2027, you won’t have to show proof that you’re meeting work requirements or you have an exemption (you’ll be able to “self-attest”). But after 2027, the state will need proof. If you think an exemption applies, make a plan now for getting your records together. To show that you meet work requirements, make a plan for keeping records of work (for example, pay stubs), school (class schedules, registration payment receipts), volunteering (attendance logs), and other qualifying activities.

The Washington Health Care Authority has more Apple Health eligibility information and about Apple Health work requirements.