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Apple Health is changing in 2027. Learn who must meet work rules, who is exempt, and simple steps to keep your Washington Medicaid coverage.

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Apple Health Is Changing in 2027: What Washington Adults Need to Know

Updated: Oct 31, 2026
Apple Health Is Changing in 2027: What Washington Adults Need to Know

Last updated: October 30, 2026

If you have Apple Health (Washington's Medicaid), you may have gotten a letter or text from the state about "work requirements." That can feel scary, especially if you see a therapist or count on other health care.

Here is the good news: most people can keep their coverage if they know the rules and act on time. This guide explains the changes in plain language and gives you clear steps to follow.

This post is general information, not legal advice. Your situation may be different. The Washington State Health Care Authority (HCA) makes the final decision about your coverage. Rules are still changing, so always check the official HCA pages listed at the end.

The short version

  • Starting January 1, 2027, many adults on Apple Health for Adults must show they work, go to school, volunteer, or have an exemption.

  • These adults will also need to renew every 6 months instead of once a year.

  • Many people are exempt, including many people with a substance use disorder or a disabling mental health condition (called "medically frail").

  • In 2027, you can self-attest. That means you tell the state what is true about you. You usually don't need to send proof unless the state asks.

  • If you lose Apple Health for Adults because you did not meet the work rules, you can't get federal tax credits for a Washington Healthplanfinder plan. That is one more reason to act early.

  • The most important thing to do right now: keep your contact information up to date and open every letter from HCA or Washington Healthplanfinder.

Why is this happening?

In July 2025, Congress passed a federal law called H.R. 1 (often called the "One Big Beautiful Bill"). It added new Medicaid rules in states, like Washington, that opened Medicaid to more low-income adults. Washington must follow these federal rules.

Who is affected?

The new work rules apply only to people on Apple Health for Adults. This is the program for adults who are:

  • Age 19 to 64

  • Not on Medicare

  • Earning under 138% of the federal poverty level

The work rules do NOT apply to:

  • Children (Apple Health for Kids)

  • Pregnant people, or people in the 12 months after pregnancy

  • People 65 and older

  • People on "classic" Medicaid because they are blind or have a disability (including people on SSI)

  • People getting long-term care services

  • American Indian and Alaska Native people (they also don't have to do 6-month renewals)

Not sure which program you have? Log in to your Washington Healthplanfinder account. Under "Coverage," look for the words "Washington Apple Health for Adults." Or call Washington Healthplanfinder at 1-855-923-4633.

What is changing, and when

  • January 1, 2027: Work requirements begin: 80 hours a month, or an exemption Who it affects: Apple Health for Adults (ages 19–64).

  • January 1, 2027: You must renew every 6 months instead of every 12 months. This starts at your first renewal in 2027. Who it affects: Apple Health for Adults.

  • January 1, 2027: "Retroactive coverage" gets shorter. This pays for care you got before you applied. It drops to 1 month for Apple Health for Adults and 2 months for other Apple Health programs. Who it affects: Everyone who applies for Apple Health.

  • October 1, 2028: Some adults will pay up to $35 for some services. This does not include primary care, behavioral health (mental health and substance use care), emergency care, pregnancy care, or family planning. Washington hasn't shared full details yet. Who it affects: Apple Health for Adults members with income above 100% of the poverty level.

Important: If you already have Apple Health, the work rules are usually checked at your next renewal in 2027, not on January 1. If you apply as a new member in 2027, they're checked when you apply. Watch your mail and email for your renewal date.

Have unpaid medical bills from October 2026? Apply by December 2026, so the shorter retroactive coverage can still reach them.

Noncitizen adults: Some lawfully present noncitizen adults, such as refugees and asylees, lost Apple Health eligibility on October 1, 2026. If this may affect you, see HCA's noncitizen page or get free legal help.

How to meet the work requirement

You meet the requirement if any one of these is true for you:

  1. Your household has at least $580 a month in income. This counts everyone in your household, not just you. If your work is seasonal, a 6-month average of $580 a month counts.

  2. You work at least 80 hours a month. That's about 20 hours a week.

  3. You go to school at least half-time. Community college, trade school, or a university all count.

  4. You are in a job-training or work program at least 80 hours a month.

  5. You do community service or volunteer at least 80 hours a month.

  6. You do a mix of work, school, training, and volunteering that adds up to 80 hours a month.

When it counts:

  • When you apply: You must meet the requirement (or have an exemption) in the month before you apply.

  • When you renew: You only need to meet it in one month out of the last 6 months.

Who is exempt from the work requirement

You do not have to meet the work requirement if any of these are true:

  • You are pregnant or within 12 months after pregnancy

  • You are a parent or caregiver of a child age 13 or younger

  • You are a parent or caregiver of a person with a disability

  • You are medically frail (see the next section — this one matters a lot for mental health)

  • You are in treatment for alcohol or drug use

  • You are a former foster youth under age 26

  • You are American Indian or Alaska Native

  • You are a veteran with a 100% disability rating

  • You are on Medicare (Part A or B)

  • You are in jail or prison, or got out within the last 90 days

  • You get SNAP (food benefits) or TANF (cash help), and your household is required to follow SNAP work rules or is following TANF work rules. HCA's papers word this in different ways, so ask HCA how it applies to you.

  • You have a short-term hardship, such as:

    • You spent part of the month in a hospital, psychiatric hospital, or nursing home (you must ask for this)

    • You had to travel out of your community for care for a serious condition, for a long time, for yourself or someone who depends on you (you must ask for this)

    • You live in an area the President has named a disaster area, or in a county where unemployment is at least 1.5 times the national rate (these are applied automatically)

If you get mental health or substance use care: "medically frail"

This part matters a lot if you see a therapist, psychiatrist, or counselor.

Under the law, you may be "medically frail" and exempt if you have:

  • A substance use disorder

  • A disabling mental disorder

  • A serious or complex medical condition

  • A physical, intellectual, or developmental disability that makes everyday tasks hard

  • Blindness or a disability (as Social Security defines it)

HCA has said that a disabling mental disorder, serious mental illness, and opioid use disorder are all included. HCA also keeps an official medically frail code list. HCA says that list does not include every condition that could qualify.

How it works in 2027

  • When you apply or renew through Washington Healthplanfinder, you will answer a screening question about being medically frail.

  • In 2027, the state will usually accept your answer without extra proof. HCA still checks its records in the background.

  • Your answer is made under penalty of perjury. That means it must be true. Only say you are medically frail if it honestly fits you. If you are not sure, talk it through with your therapist or doctor.

  • Starting in 2028, the state will first check its own records, like health care claims. It can only look back 12 months. So getting care at least once a year, with complete and correct records, really matters.

  • Starting in 2028, the federal rule lets you self-attest only once. After that, you may need to show proof.

Court ruling news from October 29, 2026

In June 2026, the federal government (CMS) put out a rule that made "medically frail" harder to qualify for. It said your condition also had to seriously limit your ability to meet the work requirement.

On October 29, 2026, a federal judge in Massachusetts ruled that this extra test goes against the law. Washington was one of the states that sued. The judge said people in the groups Congress listed, like those with a substance use disorder or a serious medical condition, qualify without that extra test.

What this ruling does not do:

  • It does not stop the work requirements. They still start January 1, 2027.

  • It did not throw out the whole federal rule. Two parts that still stand: the 12-month look-back at health records, and the limits on self-attesting after 2027.

The judge also put a six-month pause on enforcing medically frail decisions for the states that sued. It's not yet clear what that means for Washington's day-to-day process.

As of October 30, 2026, HCA has not said how this ruling will change things. Some HCA pages still say "medically frail and unable to work." Check HCA's work requirements page for updates, and ask your care team if you have questions. The federal government could also appeal.

Step by step: what to do now

  1. Find out if this applies to you. Check if you have Apple Health for Adults. Log in at wahealthplanfinder.org, or call 1-855-923-4633. If you are on a different Apple Health program, the work rules don't apply to you. You can also take the short survey on HCA's work requirements page to see if you need to act.

  2. Update your contact information today. Make sure your mailing address, phone number, and email are correct. Update them in your Washington Healthplanfinder account or at hca.wa.gov/report-a-change. If the state can't reach you, you could lose coverage without knowing why.

  3. Open every letter, email, and text from HCA or Washington Healthplanfinder. HCA started sending letters in September 2026, with texts soon after. Don't set them aside. Real HCA texts come from 833-772-9017. If you're not sure a message is real, call HCA. Put any due date on your calendar.

  4. Figure out how you qualify. Does your household have $580 a month or more in income? Work 80 hours a month? Go to school half-time? Volunteer or do a work program? Fit an exemption, like being medically frail, a parent of a child 13 or under, or in substance use treatment? If any answer is yes, write down which one fits you.

  5. Talk with your therapist, doctor, or care team. If you think you might be medically frail, bring it up at your next visit. They can talk with you about whether it fits and keep your health records complete and correct. You give the final answer on the application, not them.

  6. Keep simple records. Even though you can self-attest in 2027, keep proof in case the state asks:

    • Work: pay stubs

    • School: class schedules or registration receipts

    • Volunteering: a log with dates, hours, and a contact person

    • Health: a list of your providers and visit dates

  7. Answer quickly if the state asks for proof. If HCA can't confirm something, it will send you a "request for information." You usually have 30 days to respond, and you can ask for more time. Your coverage keeps going during those 30 days. (This comes from an HCA FAQ that says details could still change.)

  8. Renew on time, every 6 months. Starting with your first renewal in 2027, you'll renew twice a year. The state will try to renew you automatically first. If it can't, you'll get a notice asking you to act.

  9. Don't skip care. Keep your appointments and refill your prescriptions on time.

  10. Ask for help. You don't have to figure this out alone. See "Where to get help" below.

What if I lose my Apple Health?

  • You can reapply at any time. If your situation changes and you meet the rules or an exemption, apply again.

  • You have the right to a hearing (an appeal) if you think a decision is wrong. Your notice will explain how and by when. For free legal help, see WashingtonLawHelp.org.

  • You can still buy a plan through Washington Healthplanfinder. You generally have 60 days after losing Apple Health to pick one and avoid a gap.

  • But be aware: If you lost Apple Health for Adults because you didn't meet the work requirement, you can't get federal tax credits (money that lowers your monthly cost) for that plan. This is one more reason to act early.

  • Other Apple Health programs may still fit you, depending on your situation.

What about my health plan (MCO)?

Most people on Apple Health get care through one of five managed care plans: Community Health Plan of Washington, Coordinated Care, Molina Healthcare, UnitedHealthcare Community Plan, or Wellpoint.

  • Your health plan does not decide if you keep Apple Health. The state (HCA) makes that decision.

  • Your plan can still help. Call the member services number on the back of your card. They can help you find providers and set up care.

  • Keep your contact information up to date with both HCA and your health plan.

For providers and practices

  • Check eligibility. In ProviderOne, Apple Health for Adults shows as RAC 1201 or 1217 (coverage group N05). Only those clients face work requirements.

  • Code accurately. HCA uses claims data to help confirm medical frailty in the background. HCA's August 21, 2026 memo lists Z codes to include when criteria are met (Z02.71, Z51.5, Z59.3, Z73.6, Z74.01, Z74.09, Z74.1, Z74.2, Z74.3, Z74.8).

  • Don't attest for clients. Clients answer the medically frail screener themselves. Your role is to talk it through honestly and keep good records.

  • Watch for HCA updates after the October 29, 2026 court ruling.

  • Health plans (MCOs) have no new formal duties under the federal rule, but they can support members through outreach, care coordination, and keeping contact information current.

Where to get help

You don't have to sort this out alone

If you are a Talk Heal Thrive client, you are welcome to bring your questions and worries about these changes to your therapist. You can talk through what a letter means to you, how the stress is affecting you, and whether something like the "medically frail" exemption might fit. Your therapist can't give legal advice or decide your coverage. HCA makes that decision. But you don't have to carry this by yourself.

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Frequently Asked Questions

The new work requirements for Apple Health for Adults begin on January 1, 2027. They apply to adults aged 19-64 who are not on Medicare and earn under 138% of the federal poverty level. Many people are exempt, including those who are pregnant, parents of young children, or medically frail.

If you have a disabling mental disorder or are in treatment for alcohol or drug use, you may be considered "medically frail" and exempt from the work requirements. In 2027, you can usually self-attest to this. It's important to discuss this with your therapist or doctor to ensure your health records accurately reflect your condition, especially for verification starting in 2028.

The most critical steps are to update your contact information (mailing address, phone, email) with Washington Healthplanfinder or HCA. You should also open every letter, email, and text you receive from HCA or Washington Healthplanfinder, as these will contain vital information about your coverage and renewal.

Starting January 1, 2027, if you are on Apple Health for Adults, you will need to renew your coverage every 6 months instead of once a year. This change will begin with your first renewal notice in 2027.

On October 29, 2026, a federal judge ruled that the state cannot add an extra test requiring your condition to "seriously limit your ability to meet the work requirement" for the "medically frail" exemption. This means people with conditions like a substance use disorder or disabling mental disorder should qualify without that extra hurdle. However, the work requirements still begin January 1, 2027, and some parts of the federal rule, like the 12-month look-back at health records, still apply.

As a Talk Heal Thrive client, you are welcome to bring your questions and concerns about these changes to your therapist. They can help you process the stress, understand how the changes might affect you, and discuss whether the "medically frail" exemption could apply to your situation. While your therapist cannot provide legal advice or make coverage decisions, they can support you and ensure your health records are accurate.