The Health Care Authority (HCA) administers Washington's Apple Health Program providing medical assistance primarily through Medicaid for low-income state residents who meet certain eligibility criteria. Apple Health offers?a complete medical benefits package to?eligible families, children under age 19, low-income adults, certain disabled individuals, and pregnant individuals.

Apple Health provides coverage to pregnant individuals and postpartum persons with countable income at or below 193 percent of the federal poverty level, regardless of citizenship or immigration status. ?Once an individual is enrolled in Apple Health coverage and is pregnant, the individual remains continuously eligible for 12 months following the end of a pregnancy, regardless of any change in income during that period.?

Maternity Care Access Act. ?Under the state's Maternity Care Access Act, HCA?established the First Steps Program to provide access to services for eligible clients and their infants. ?The Maternity Support Services Program is a component of First Steps and delivers enhanced preventive health and education services and brief interventions to eligible pregnant clients to improve and promote healthy birth outcomes. The services are provided as early in pregnancy as possible, based on the client's individual risks and needs. ?State regulations establish client eligibility, qualifications, and requirements for providers to participate, and documentation and reimbursement requirements.

Apple Health Coverage for Pregnant and Postpartum Persons. By November 1, 2024, the countable income standards for a pregnant person and a postpartum person eligible for Apple Health coverage is at or below 210 percent of the federal poverty level.
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Post-delivery and Transitional Care Program.?By no later than January 1, 2026,?HCA must create a post-delivery and transitional care program (the program) allowing for extended postdelivery hospital care for people with a substance use disorder at the time of delivery. The program must allow up to five additional days of hospitalization for the birth parent and allow dedicated time for health professionals to assist in facilitating early bonding between the birth parent and infant. The program should also provide the birth parent access to:

• integrated care and medical services including access to clinical health, medication management, behavioral health, addiction medicine, specialty consultations, and psychiatric providers; and
• social work support, which includes coordination with the Department of Children, Youth, and Families, to develop a plan for safe care.

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HCA must establish provider requirements, and pay only those qualified providers for the services provided through the program. In administering the program, HCA must seek any available federal participation through Medicaid or other federal funding sources. ?

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To provide technical assistance to hospitals participating in the program, HCA must contract with the Washington chapter of a national organization that provides a physician-led professional community for those who prevent, treat, and promote remission and recovery from the disease of addiction and whose comprehensive set of guidelines related to substance use disorders and co-occurring disorders have been incorporated into Medicaid managed care contracts.

Maternity Support Services Program. The Maternity Support Services Program (MSSP) must be updated to address perinatal outcomes and increase equity and healthier birth outcomes. By January 1, 2026, HCA must:?

• update current screening tools to be culturally relevant, include current risk factors, ensure the tools address health equity, and include questions identifying various social determinants of health;
• ensure care coordination;
• increase the allowable benefit and reimbursement rates with the goal of increasing the use of services to all MSSP clients; and
• develop a mechanism to collect results of the MSSP screenings and evaluate the outcomes of the MSSP.

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The MSSP evaluation must identify gaps, strengths, and weaknesses and make recommendations for how the MSSP may improve to better align with HCA's maternal and infant health initiatives.

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