By Aaron Allen, The Seattle Medium
Thousands of King County residents could face changes to their health coverage beginning Oct. 1 as new federal Medicaid rules begin taking effect in Washington, followed in January by work requirements, more frequent eligibility renewals and shorter retroactive coverage periods for many adults enrolled in Apple Health.
The changes stem from H.R. 1, the federal law enacted in July 2025 that made significant changes to Medicaid and other health coverage programs. In Washington, the changes will be implemented in stages, beginning with new eligibility restrictions affecting some lawfully present noncitizen adults.
For health care providers and outreach officials, the concern extends beyond whether people technically qualify for coverage. They worry that people who lose insurance or have difficulty navigating the new requirements could delay routine and preventive care until their health problems become more serious.
“The impacts are devastating,” said Dr. Shaquita Bell, senior medical director at Odessa Brown Children’s Clinic and Seattle Children’s Hospital. “We know that health insurance is the equivalent of health in our country, it determines whether you access preventative healthcare like vaccines and physicals. We also know that the health of adults directly impacts children. What I worry about the most is these changes are going to make people stop getting care until there’s an emergency.”
Public Health – Seattle & King County is trying to prepare residents for the changes through its Access & Outreach program, which works with community organizations and certified health insurance navigators to help people understand eligibility requirements and identify coverage options.
Daphne Pie, regional health administrator for the Access & Outreach program at Public Health – Seattle & King County, said the consequences could be particularly significant in communities that already experience disparities in health coverage and access to care.
“When we think about our communities of color especially Black, Hispanic/Latinx, and Asian Pacific Islander communities, we face high health disparities and high uninsured rates. What Apple Health expansion did was help level that playing field for the most vulnerable,” explained Pie. “When an individual loses that safety net—someone going to the doctor, getting cancer or kidney treatment, or needing daily medication, they walk into the pharmacy and are told they no longer have coverage. Imagine that impact.”
The first major change takes effect Oct. 1 and affects eligibility for some lawfully present noncitizen adults. According to the Washington State Health Care Authority, changes will affect refugees, asylees and some other noncitizens who currently qualify for Apple Health.
Approximately 4,000 King County residents could lose Apple Health coverage as a result of the noncitizen eligibility changes, according to Pie.
Some people affected by the change may qualify for other forms of health coverage depending on their circumstances, including immigration status, pregnancy status or eligibility for a Qualified Health Plan through Washington Healthplanfinder. Navigators are working with residents to review individual cases and identify possible alternatives.
The federal law, however, also changes eligibility for subsidies used to purchase Qualified Health Plans. Beginning Jan. 1, 2027, many lawfully present immigrants will no longer qualify for federal subsidies, and people who are denied Medicaid eligibility because they do not meet the new work requirements will also be ineligible for federal subsidies through a Qualified Health Plan.
Bell emphasized that children and pregnant people may qualify for Apple Health through programs that are not subject to the same changes affecting Apple Health for Adults. She also said losing insurance does not mean families should stop seeking medical care.
“Odessa Brown will still take all patients—we do not restrict access based on insurance status or the type of insurance you have, caring for patients up to the age of 21,” emphasized Bell, noting that Seattle Children’s also provides dedicated financial aid counselors to help families navigate their options. “If people have healthcare right now, they should connect with their clinic or provider to understand how this change impacts their relationship. There are still options out there, even if they lose their insurance.”
A second set of changes begins Jan. 1, 2027, for people enrolled in Apple Health for Adults.
Under the new rules, those enrollees will generally have to meet a work or community-engagement requirement or qualify for an exemption to maintain coverage. The requirement can be met by working at least 80 hours a month, participating in qualifying work or community service programs, attending an education program at least half-time or earning at least $580 in monthly household income. Qualifying activities can also be combined to meet the 80-hour requirement.
Some Apple Health for Adults enrollees will be exempt from the work requirements based on circumstances established under the federal law. State officials are providing guidance about exemptions and how eligibility will be verified.
The changes also increase how often people enrolled in Apple Health for Adults must demonstrate that they remain eligible for coverage. They will be required to renew every six months instead of once a year.
Pie expressed concern that more frequent renewals could cause eligible residents to inadvertently lose coverage, particularly when people move or fail to receive or respond to notices.
“It can be very problematic because you’re working with folks who sometimes don’t check their mail or move, so they never get the notices. They make the assumption their insurance is renewed automatically, only to find out it’s lapsed,” said Pie. “What’s deeply concerning is we have many individuals who cannot work due to physical, mental, or other barriers and risk losing access.”
Retroactive Medicaid coverage will also become more limited beginning Jan. 1. For Apple Health for Adults, the retroactive coverage period will decrease from three months to one month. For other Apple Health programs, including coverage for children and pregnant people, the period will decrease from three months to two months.
More than 200,000 King County Apple Health enrollees could be affected by the broader eligibility and administrative changes beginning in 2027, according to Pie.
State and local health officials are urging Apple Health recipients to make sure their mailing addresses, email addresses and other contact information are current so they receive notices about their coverage and renewal requirements.
The Health Care Authority says Apple Health for Adults clients are being notified about the upcoming work requirements and six-month renewal periods. Many of the changes will affect individuals when they apply for coverage or reach their next renewal after implementation.
Public Health – Seattle & King County is also providing training to health insurance navigators, hospital representatives, community organizations and other outreach workers through its First Friday Forum as agencies prepare to help residents navigate the new rules.
“Our goal is the exact opposite of what these federal cutbacks intend—our goal is to keep people covered,” noted Pie. “If you are on Apple Health right now, allow our certified navigators to educate you on how to process exemptions, document volunteer or caregiving hours, and protect your healthcare access.”
King County residents who have questions about their coverage or need help navigating the changes can contact the county’s Community Health Access Program, or CHAP. The free and confidential program helps residents connect with health insurance, health care services and other resources.
Residents can reach CHAP at 1-800-756-5437 or find information at kingcounty.gov/chap. Information about upcoming Apple Health changes is also available through the Washington State Health Care Authority.
