WSR 13-21-097
[Filed October 21, 2013, 10:02 a.m.]
Title or Subject: Apple Health Plus Managed Care Program.
Effective Date: February 1, 2014.
Description: Medicaid State Plan Amendment 13-42.
Beginning January 1, 2014, the state of Washington will implement portions of the Affordable Care Act (ACA) by:
Expanding medicaid eligibility to individuals with a modified adjusted gross income up to one hundred thirty-eight percent of the federal poverty level (FPL); and
Offering qualified health plans (QHPs) through Washington's health benefit exchange (HBE) to individuals not eligible for medicaid. A QHP is a commercial insurance plan that follows established limits on cost-sharing (like deductibles, copayments, and out-of-pocket maximum amounts), and meets other requirements of the ACA.
The health care authority (HCA) anticipates many individuals with incomes near the eligibility threshold of one hundred thirty-eight percent FPL will experience frequent changes in their family income. When their income exceeds the threshold, they will lose their medicaid eligibility and will instead be eligible for QHP coverage through the HBE. When their income drops below the threshold, they become eligible for medicaid. As their income fluctuates, so does their eligibility for either of these insurance affordability programs. This movement between the programs is commonly referred to as "churn."
To address this "churn," HCA intends to implement the apple health plus (AHP) program. The goal of this voluntary program is to ensure continuity of care for individuals and families. AHP will be a medicaid managed care program that will allow QHP enrollees who experience changes in income to remain with the same insurance carrier when they transition from QHP coverage to medicaid, if the carrier is contracted with HCA as a limited medicaid managed care organization. Current medicaid enrollees with family members enrolled in a QHP will also have the option to enroll in AHP.
To obtain approval for AHP, the HCA intends to submit a 1932(a) State Plan Amendment 13-42, adding AHP as a new program to Washington's medicaid state plan.
For additional information, contact Robert Longhorn, Division of Health Care Services, P.O. Box 45530, Olympia, WA 98504, phone (360) 725-0764, TDD/TTY 1-800-848-5429, fax (360) 753-7315, e-mail