Navigating Challenging Changes to Apple Health (Medicaid)

This fall and winter the new federal legislation known as H.R.1 goes into effect and with it comes big changes to Apple Health (Medicaid) eligibility and enrollment policies. The new rules are challenging and confusing, and community health centers are here to help. 

Eligibility and Enrollment Specialists at local community health centers can get patients information about their insurance options. The Washington Health Benefit Exchange’s navigator resource page can help you locate a navigator or enrollment specialist near you. If you are unsure if the recent Apple Health (Medicaid) changes impact you, it’s best to speak with one of these helpful folks to assess your unique situation. 

Here’s a little information about these changes and who they’ll impact: 

On October 1, 2026, new federal rules changed Medicaid (Apple Health) eligibility criteria for lawfully present noncitizens adults, including asylees and refugees. Overnight between 11,000 and 14,000 individuals in Washington state lost access to Apple Health Coverage as a result of H.R. 1 being implemented. Patients meeting at least one of the following criteria should still qualify for other programs:

• Under age 19
• Pregnant or postpartum
• Have an emergency medical condition
• Receiving Aged, Blind, or Disabled (ABD) cash assistance

On January 1, 2027 adults (ages 19-64) on Apple Health (Medicaid) must meet a community service requirement, commonly known as a work requirement. This includes 80 hours a month of work, community service, school, or a work program. These same individuals will also be required to renew their Apple Health coverage every six months instead of every 12 months.

Some people may qualify for work requirement exemptions including but not limited to:

• Pregnant/Postpartum people
• Caregivers (including parenting a child under 14)
• People determined to be Medically Frail
• American Indian/Alaska Native individuals

Check out WA Health Care Authority’s info about work requirements and take their screener to see if the new work requirements apply to you. 

H.R.1 isn’t the only change causing people to lose their health care coverage. At the end of 2025 Congress failed to renew ACA tax credits, causing higher out-of-pocket health insurance premiums on state exchanges. As the state’s largest primary care safety net, Washington’s community health centers are helping uninsured and underinsured patients. During this time, and always, health centers are committed to working with the state to continue serving patients.