Last updated on November 6th, 2026 at 09:37 pm
If your elderly parent or disabled family member recently lost their Apple Health Medicaid coverage on September 30, you’re not alone. Perhaps they received a letter in August in a language they cannot read easily. They still need their caregiver and they have upcoming appointments scheduled.
These Medicaid changes resulted from federal law, H.R.1, which was signed July 4, 2025 and became effective October 1, 2026. On October 1, approximately 11,000 Washingtonians lost their Apple Health coverage, according to the Washington State Health Care Authority.
Here is what you should know and what to do this week. The rules apply statewide.
Who Is Affected by the October Medicaid Changes
Starting October 1, 2026, federal law narrowed which lawfully present immigrants can receive Washington’s Apple Health coverage. The change applies to adults age 19 and older.
According to the HCA noncitizen fact sheet, the following groups lost Apple Health coverage after September 30, 2026:
- Refugees and asylees who have not become lawful permanent residents
- People granted withholding of deportation or removal
- Survivors of human trafficking
- Violence Against Women Act (VAWA) self-petitioners (survivors of domestic violence with a pending or approved petition)
- Conditional entrants
- Certain parolees, including some Afghan and Ukrainian parolees admitted within specific date ranges
These groups keep Apple Health if they meet other requirements:
- U.S. citizens and U.S. nationals
- Lawful permanent residents (green card holders) who have met the five-year waiting period or are exempt from it
- Compact of Free Association (COFA) islanders
- Cuban and Haitian entrants
- Children under 19, and people who are pregnant or within 12 months after pregnancy, regardless of immigration status
A refugee or asylee who later got a green card stays exempt from the five-year bar. HCA reports that roughly 3,000 people kept coverage because their immigration status was updated in state records.
A separate court order protects another group. On September 30, 2026, a federal judge in Seattle issued a preliminary injunction. It protects lawfully present immigrants who receive Supplemental Security Income (SSI). HCA says more than 800 Washingtonians keep Apple Health under that order while the case continues.
The October change affects long-term care as well. DSHS estimates 876 clients receiving long-term services and support were affected. These clients include older adults and people with disabilities, 93% of whom receive care in their own homes.
Apple Health Expansion, the state-funded program for adults who do not qualify for federal benefits, closed to new enrollment in December 2025. Current enrollees keep their coverage. It is not an option for people who lost Apple Health this month.
What Coverage Is Still Open After Losing Apple Health
HCA lists several programs that stay open to people who lost Apple Health. Each has its own rules.
Apple Health programs that continue
- Apple Health for Pregnant Individuals and After-Pregnancy Coverage. You must report a current pregnancy, or a pregnancy that ended after October 2025.
- Alien Emergency Medical (AEM). This program covers emergency care. HCA asks you to report ongoing dialysis, cancer treatment, or anti-rejection medication.
- Medical Care Services (MCS). This is a limited, state-funded medical benefit tied to state cash or housing assistance programs. It covers long-term care only in nursing or residential settings, not in-home care.
- Apple Health for Kids. Children under 19 keep full coverage.
Washington Healthplanfinder plans
Anyone living in Washington can buy a health plan through Washington Healthplanfinder, regardless of immigration status. Families who lost Apple Health received an eligibility results notice in late August. They have 60 days from that notice to pick a plan.
Financial assistance comes in two layers. Through December 2026, many lawfully present adults may still qualify for federal premium tax credits. The usual threshold is income at or above the federal poverty level. Starting January 1, 2027, those credits are limited to lawful permanent residents, COFA islanders, and Cuban and Haitian entrants.
The second layer is Cascade Care Savings, a state premium subsidy. Immigration status does not affect it, although benefits depend on state funding each year. The eligible income limit is 250 percent of the federal poverty level, about $40,000 a year for one person.
If Your Family Member Receives Long-Term Care
Some families have a caregiver that comes to their house. Others have a parent in an adult family home. These families face the hardest version of this change. Washington DSHS created a state-funded service to bridge the coverage gap.
The Limited Benefit Community Access Program (LB-CAP) started October 1, 2026. It is for Home and Community Services and Developmental Disabilities Administration clients who lost Apple Health. People enrolled in LB-CAP keep the same services they had on September 30.
Funding is limited. DSHS reported 173 initial slots statewide. Top-priority clients were those living in a 24-hour residential setting as of July 31, 2026. That includes adult family homes and nursing facilities. Remaining openings went to clients with the highest assessed care needs.
Everyone else was placed on a waitlist, prioritized by care needs and time on services. DSHS sent a Planned Action Notice in September notifying each client whether they were enrolled or waitlisted. If you cannot find that notice, call the case manager.
Two older state programs also exist, each with a waitlist. They are the Non-Citizen State-Funded Long-Term Care program and the DDA Adult Non-Citizen program. Your case manager can tell you whether either applies.
For in-home clients, the local Area Agency on Aging can connect families to other help. These agencies screen for the Family Caregiver Support Program, home-delivered meals, medical transportation, and legal referrals. In Snohomish County, that agency is Homage. In Whatcom, Skagit, Island, and San Juan Counties, it is the Northwest Regional Council.
Step-by-Step: What to Do This Week
Work through these in order. Most families can finish steps one through three in a single afternoon.
- Gather the notices. Find the August information letter, the late-August eligibility results notice, and the termination notice. The eligibility results notice sets your 60-day window for Healthplanfinder.
- Report anything that changed. A green card approved or pending, a pregnancy, SSI, dialysis, cancer treatment, or anti-rejection medication can restore coverage. Ages 19 to 64: call HCA at 1-800-562-3022 or use hca.wa.gov/report-a-change. Clients age 65 and older, or anyone receiving long-term care, should call DSHS at 1-877-501-2233 or use Washington Connection.
- Price a Healthplanfinder plan before the window closes. Call 1-855-923-4633 or ask for a free navigator in your language. Ask specifically about Cascade Care Savings. The Exchange also answers immigrant coverage questions at immigrantcoverage@wahbexchange.org.
- Call the long-term care case manager. Confirm LB-CAP enrollment or waitlist status. Ask the Area Agency on Aging about the Family Caregiver Support Program if a family member is now providing care.
- Keep medical appointments. Tell each provider that coverage changed. Community health centers see patients on a sliding fee scale. Ask the pharmacy about short-term refill options before a prescription runs out.
- Get accredited immigration help. If your family member may qualify to adjust to permanent resident status, that step restores Apple Health eligibility. Use an accredited representative or attorney, never a notario.
- Keep contact information current. State agencies send notices by mail and email, and an old address means a missed deadline. Update contact information with HCA, DSHS, and Healthplanfinder.
How Sunrise Helps Families Through Coverage Changes
Sunrise Services has worked alongside DSHS programs in the North Sound for decades. Eligibility is decided by DSHS and HCA. We can help you read your care authorization and plan what happens next.
Our home care agency holds state contracts for Medicaid Personal Care, COPES, and In-Home Respite. We serve Snohomish, Whatcom, Skagit, and Island Counties. If your family member moves to LB-CAP, authorized hours and services carry over. For families waiting on coverage, we also offer private pay rates.
Families considering a residential setting can learn about our adult family homes, which accept private pay. Some family members still have Apple Health or Medicare and live with chronic conditions. For them, our Health Home care coordinators help manage referrals and transitions between providers.
You can see the full range of support on our services page.
Frequently Asked Questions
Did Washington end Medicaid for all immigrants in October 2026?
No. The October Medicaid changes affected specific lawfully present groups, mainly refugees, asylees, trafficking survivors, and certain parolees. Lawful permanent residents, COFA islanders, Cuban and Haitian entrants, children, and pregnant people remain eligible if they meet other requirements.
Can my family member get Apple Health back?
Yes, in several situations. Becoming a lawful permanent resident restores eligibility, and refugees and asylees who adjust their status skip the five-year wait. Pregnancy, SSI under the current court order, and certain emergency medical needs also qualify a person for coverage. Report the change to HCA or DSHS right away.
What is LB-CAP in Washington?
LB-CAP is the Limited Benefit Community Access Program, a state-funded program that began October 1, 2026. It lets some long-term care clients who lost Apple Health under H.R. 1 keep the same services. Enrollment is capped at 173 initial slots, with a waitlist ordered by care needs.
Is there a deadline to choose a Washington Healthplanfinder plan?
Yes. People who lost Apple Health have 60 days from their late-August eligibility results notice to select a 2026 plan. Coverage starts October 1, 2026. Open enrollment for 2027 plans begins November 1, 2026.
What if we cannot afford any health plan?
Start with a Healthplanfinder navigator and ask about Cascade Care Savings, which lowers premiums for many families. Community health centers provide care on a sliding fee scale. Alien Emergency Medical still covers emergencies. Call 211 or visit wa211.org for food, rent, and utility help.
Your Next Step After the October Medicaid Changes
The October Medicaid changes took coverage from thousands of Washington families. The path back is narrow, but it is real. Report every change, use the 60-day window, and contact your case manager immediately.
If your family member needs care at home or in a residential setting while coverage is sorted out, we can help.
Click here to talk with Sunrise about home care options for your familyMore Apple Health changes take effect on January 1, 2027, including work requirements and six-month renewals for adults. Click here to read what Washington families need to know about the 2026 and 2027 Medicaid changes.
| DISCLAIMER: The information in this article is for general informational purposes only and does not constitute medical, legal, or financial advice. Please consult a qualified healthcare provider regarding your specific situation. For questions about immigration status, consult an accredited immigration representative or attorney. |