Washington Medicaid is a comprehensive health plan for low-income families living in the state of Washington. The program provides numerous health care services through manage care and fee-for-services. Eligible individuals and families will receive coverage for children as well as coverage for adults and elderly living in the household.

The services provided through the program cover your appointments with a doctor, emergency medical care, mental health care, maternity care, dental care, prescription drugs, transportation for medical appointments, and treatment for drug abuse.

The program compares monthly income to Federal Poverty Level (FPL) to decide about your eligibility. There are various other factors that will determine your eligibility for different Medicaid services. These factors may include age, number of household members, children living in the household, pregnant women living in the household, and people with disability living in the household.

Washington Medicaid also provides personal care for elderly and disabled. A HCS social worker will visit you to determine your eligibility for personal care. The assessment will be used to see whether you need care and if you do, what level of care services you need. Depending on your needs, programs such as Medicaid Personal Care (MPC) and Community Options Program Entry System (COPES) will be paying for such services.

If you meet eligibility requirements for Personal Care, you can be allowed to hire a caregiver. You will have the choice to choose whoever you want but DSHS will only pay if you pick a qualified caregiver or Individual Provider (IP). You can also choose any of your relative as your IP. You can also choose a licensed home care agency, which will provide a caregiver.

There are various additional services available to qualified adults. These are Adult Day Services, Environmental Modifications, Home Delivered Meals, Individualized Training, Personal Emergency Response System, Medical Equipment, and Transportation.

If you are not eligible for Washington Medicaid, you can apply for Basic Health. Basic Health is a low cost health coverage for families that don’t qualify for Medicaid but are within certain income limits. You can also apply for benefits through Benefits Checkup program if you are 55 and over. You will be able to find many services that will take care of your essential expenses.

You can call at 1-800-562-3022 for more details on the program. You can either wait for the customer service representative or proceed yourself through self-service options.

Eligibility Requirements

In order to receive benefits through Washington Medicaid program, you will have to meet different eligibility requirements, such as

• You must be a U.S citizen or a qualified alien

• You must be a resident of state of Washington

Income and resources eligibility

Individuals and families will have to meet income eligibility guidelines in order to receive benefits through Washington Medicaid.

If you are elderly but not disabled, your income must be 70% or less of the Federal Poverty Level (FPL). Your monthly income will include earned income as well as unearned income. Earned income is the money you earn before deducting taxes while the unearned income is additional payment your receive through retirement funds, child support, unemployment aid, SSI etc. You will also have to disclose your resources such as bank accounts, real estate and any other resources that you may have. You’ll have to calculate income and resources of your household, meaning of every member living in the household.

Your income eligibility will be determined by a HCS financial services specialist, who will either work in person, through telephone or mail to determine your eligibility.

Determining eligibility through online tool

One of the easier ways to find out whether you are eligible for Washington Medicaid is to use Trial Eligibility Calculator. You get to choose answers to six questions and you see a complete chart of benefits that you can apply. The six factors that the calculator uses are

1- Number of members in the household

2- Number of children living in the household

3- Monthly earned income

4- Monthly un-earned income

5- Resources

6- Payments for child support

After you answer these six questions, you will get a ‘rough’ idea about your eligibility. However, this is just a trail calculator and its results does not mean more than just a ‘trial’. Different programs consider some other factors such as age, disability, and pregnant in order to determine eligibility.

You can use the eligibility calculator in Spanish as well.

 

Medicaid Application Instructions

Apply online: You can apply online for Washington Medicaid. Click ‘Apply for Services’ and you’ll reach a secure page where you can complete your application. You’ll find step-by-step instructions while filling the application. You don’t have to worry about providing your data online. The application form is provided through a secure internet page and all the data is protected. It will take about an hour to complete the online application process.

Once done, you will be able to manage your account and access various federal and state resources. You will also be able to track your status later through My Account.

Apply in person: You can also apply in person for Washington Medicaid. Just visit your nearest Community Services Office (CSO) and you’ll get all the information and necessary application forms. Use this office finder tool to locate your nearest CSO.

Apply through mail: You can also apply for Washington Medicaid through mail. You will first have to get an application from HCS office or download one.