Cost and Coverage of Medicaid in Washington

Washington Medicaid coverage has a number of programs that provide low-cost or free medical services to eligible members. The Washington Medicaid services program is known as Apple Health and offers complete major medical coverage. Apart from Apple Health, there are other programs that come with limited benefits. What services are covered by Medicaid WA? The Medicaid services covered depend on the different types of Medicaid insurance.

The sections below discuss WA Medicaid coverage and costs through the following topics:

  • What services are covered by Medicaid in Washington?

  • How much does Medicaid cost in Washington?

  • What does Medicaid not cover in Washington?

  • Types of Medicaid insurance in Washington

What services are covered by Medicaid in Washington?

Washington Medicaid coverage caters to a number of medical services. Some of what is covered by Medicaid services is available to patients through fee-for-service or managed care. They include hospitalization, laboratory and X-ray services, prescription medications, limited vision and dental care for adults and pediatric services, including vision and dental care.

Other covered Medicaid services in WA include treatment for alcohol and chemical dependence, mental health services, maternity and newborn care, medical care in an emergency, appointments with a health care professional or a doctor for necessary care and an interpreter during an appointment (for non-English speakers).Washington Medicaid coverage also allows for some optional health care services for cost. How much is Medicaid when services are not entirely free? The Medicaid cost estimates vary depending on the service selected. These medical services are offered on a fee-for-service basis and include:

  • Alcohol and substance abuse services, including detoxification and inpatient and outpatient services. These health services are offered by agencies certified by the Department of Social and Health Services (DSHS).

  • Long-term care services for people with developmental disabilities.

  • Dental services. To get dental services, patients need to sign up with a dental provider who has agreed to be an Apple Health fee-for-service provider.

  • Eyeglasses and fitting services are covered for patients that are below 21 years old. The services are offered through an Apple Health fee-for-service provider.

  • Maternity support services.

  • Early Support for Infants and Toddlers (ESIT) up to the age of 3.

  • Osteopathic manipulative therapy service – which is covered with limited benefits. For manipulations to be covered by the health plan, they have to be performed by a doctor of osteopathy.

  • Voluntary pregnancy terminations, including termination and follow-up care for any complications.

  • Transgender health services, such as postoperative complications and surgical procedures.

  • Transportation for medical appointments.

What does Medicaid not cover in Washington?

While what is covered by Medicaid includes a lengthy list of benefits, there are several medical services that WA Medicaid coverage does not cover. Each state decides the on the Medicaid services it would like to offer patients, and which ones will require payments by beneficiaries. What is not covered by Medicaid in Washington? Washington Medicaid coverage excludes the medical services below:

  • Alternative medicine (massage therapy, homeopathy, herbal therapy, faith healing, Christian Science practice and acupuncture)

  • Chiropractic care for adults

  • Plastic or cosmetic surgery (including hair transplants, ear or body piercing, face lifts and tattoo removal)

  • Diagnosis and treatment of sexual dysfunction, impotence and infertility

  • Marriage counseling and sex therapy

  • Personal comfort items

  • Non-medical equipment (for example, ramps and other home modifications)

  • Physical exam needs for licensing, insurance or employment

  • Services not allowed by State or Federal Law

  • Weight control and reduction services (gym memberships, weight loss products, slimming pills or equipment used for weight loss purposes)

If patients elect to schedule appointments for any of the medical procedures or treatments listed above, they will be fully responsible for taking care of the costs. If what is not covered by Medicaid is deemed medically necessary by a doctor, a beneficiary can request to receive approval for the health service, but there are no guarantees.

How much does Medicaid cost in Washington?

Medicaid coverage costs in Washington vary depending on different factors. During application for Medicaid services, applicants have to provide information about their incomes, assets and dependents whose names will be on their programs. Washington Medicaid coverage premiums will be determined after considering all these factors. How much is Medicaid for the average beneficiary? Medicaid cost estimates in Washington range on a wide scale from nothing at all to a few thousand dollars, depending on the services or procedures a patient needs, paired with his or her benefits.

Washington Medicaid services uses a Managed Care program. Most consumers that apply for Medicaid coverage Washington have will select a Managed Care Organization (MCO) from which to receive health care. This means that Apple Health pays a health plan a monthly fee for the client’s care. The fee covers the cost of providing specialty, primary, preventive and other health services.

The majority of Medicaid services covered are included with enrollment into an MCO. However, some Medicaid services are paid through a “fee-for-service” model. In this model, WA Medicaid pays the providers and doctors directly instead of through a health plan.

Types of Medicaid Insurance in Washington

When you apply for Medicaid coverage in Washington, you will have to sign up with an insurance plan provider. If you apply for WA Medicaid but already have insurance, what happens next?

After enrolling for Medicaid in Washington, you will receive a blue Services Card in mail within one to two weeks. The card is also known as a ProviderOneCard and proves that you are enrolled in Apple Health. The card should be produced during hospital visits and when choosing prescription drugs.

A month after enrolling for WA Medicaid services, a white card with the name of your managed care plan will be sent. WA Medicaid’s managed care plans are Amerigroup (AMG), Community Health Plan of Washington (CHPW), Coordinated Care of Washington (CCW), Molina Healthcare of Washington, Inc. (MHW) and United Healthcare Community Plan (UHC).

Patients can select a new health plan or change the existing one at any time online. The health plan change will come into effect on the first day of the next month. Beneficiaries can switch medical coverage plans by calling the Health Care Authority, printing an online enrollment form or requesting a change online.



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