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, a Washington Health Care Authority representative, or a DSHS case manager regarding your specific situation.
If you have an aging parent, a partner, or a loved one with a disability who relies on Apple Health for home care here in Washington, the news about Medicaid changes in 2026 may be feeling like a lot. New rules. New deadlines. New federal terminology. It is a fair time to feel uneasy.
Here is the calm version. The biggest Medicaid home care changes 2026 do not erase Apple Health home care in Washington. Most families currently receiving services will continue to receive them. What is changing is the framework around the program: a new federal payment rule that begins phasing in this year, an October 1 eligibility change for some noncitizens, and a longer rollout of renewal and work requirements that arrive in 2027.
This guide walks through what is actually changing, what is not, and a short action checklist for Washington families.
What’s Actually Changing in 2026
Two separate sets of federal rules are reshaping Medicaid in 2026. They are easy to confuse with each other, so it helps to keep them apart in your head.
- The CMS Access Rule (the 80/20 rule). This is a workforce rule from the Centers for Medicare and Medicaid Services. It requires that at least 80% of Medicaid payments for home care services go to direct care worker pay rather than administrative overhead. Reporting begins in 2026; full compliance with the 80% pass-through is required by 2030.
- H.R. 1, the One Big Beautiful Bill Act (OBBBA). This is the federal budget law signed in July 2025. It changes who can be enrolled in Medicaid (Apple Health), how often eligibility is rechecked, and adds future work-related requirements. The first major OBBBA change for Apple Health hits October 1, 2026, with larger changes following in 2027.
In Washington State, both sets of changes flow through the Washington Health Care Authority (HCA) and DSHS. When you see HCA or DSHS mail this year, that is the source.
The 80% Payment Rule, In Plain English
The 80/20 rule is the Medicaid policy you may have seen described as the 80% pass-through. The federal Centers for Medicare and Medicaid Services finalized it in 2024 as part of the Ensuring Access to Medicaid Services rule.
In short: when a state Medicaid program pays a home care agency for personal care, homemaker, or home health aide services, at least 80% of that payment has to reach the workers who actually provide the care. The remaining 20% covers administrative costs like scheduling, training, and compliance.
For Washington families, the practical effect is on caregiver wages and workforce stability. A more stable, better-compensated caregiver workforce means fewer canceled visits, less turnover, and stronger continuity of care for your loved one. The full 80% requirement does not take effect until 2030, but state reporting on payment rates begins in 2026.
If your loved one currently uses Sunrise Services or another Washington home care agency under Apple Health, you do not need to take action because of the 80/20 rule. The rule applies to providers and the state, not to families.
October 1, 2026: Medicaid Eligibility Changes for Some Noncitizens
This is the change that has triggered the most confusion in our communities, so it is worth explaining carefully.
Under Section 71109 of OBBBA, starting October 1, 2026, federal Medicaid eligibility is restricted to four groups: U.S. citizens, certain lawful permanent residents (green card holders), Cuban and Haitian entrants, and people in the U.S. under a Compact of Free Association (Marshall Islands, Micronesia, and Palau).
Several groups who were previously eligible for federal Medicaid will no longer be: refugees, people granted asylum, people with humanitarian parole status, and certain abused spouses and trafficking survivors. The same restrictions apply to the Children’s Health Insurance Program (CHIP).
In Washington, the Apple Health Expansion program (the state-funded coverage that has covered some adults regardless of immigration status) closed to new applications in December 2025. Adults already enrolled keep their coverage for now.
If your household is mixed-status (some members are citizens or green card holders and others are not), the rules can be confusing and they vary by household member. Do not guess. Contact DSHS or a local navigator before October 1 to confirm which family members are affected.
What’s NOT Changing Right Now
It is easy to read federal news and assume your services are about to disappear. They are not. Here is what stays the same in 2026:
- Apple Health home care continues for currently enrolled, eligible Washington residents.
- COPES, Medicaid Personal Care (MPC), and In-Home Respite remain active. These are the Washington programs most home care recipients use, and Sunrise Services holds state contracts for all three.
- Eligibility for current Apple Health enrollees who are U.S. citizens or qualifying lawful permanent residents is not affected by the October 1 change.
- The biggest day-to-day shifts (six-month renewals for adults, community engagement / work requirements) are scheduled for 2027, not 2026. You do not need to do them this year.
- Sunrise Services continues to serve Snohomish, Whatcom, Skagit, and Island Counties with the same care plans, the same teams, and the same Apple Health contracts.
If your loved one is currently receiving home care through Sunrise or any Apple Health home care agency, the most important thing you can do in 2026 is keep your contact information current with HCA. The next year is when notices, redeterminations, and information requests will start arriving.
Your Action Checklist for 2026
A short list, in the order it makes sense to do them.
- Update your contact information with HCA. Log in to your Washington Healthplanfinder or Apple Health account and confirm your address, phone, and email. Most coverage problems in 2026 will trace back to a notice that was mailed to an old address.
- Check your renewal date. Apple Health typically renews once per year. Note when yours is due so you do not miss the window.
- If your household is mixed-status, get a one-on-one consultation. Contact DSHS or a community-based navigator before October 1, 2026. Bring documentation of immigration status for each household member.
- Document the home care services already in place. Keep a simple file: who provides care, the program funding it (COPES, MPC, In-Home Respite), the case manager’s name, and the assessed hours. If something changes, you will already have the baseline.
- Talk to your home care provider about contingency. If anything in your situation changes (income, household composition, or your loved one’s needs), tell your provider promptly. They can help you reassess hours and stay ahead of redeterminations.
- Save these links. WA HCA: Changes coming to Apple Health. DSHS: Benefits and H.R. 1.
Sunrise Helps Washington Families Navigate Changes in Caregiving Funding
Sunrise Services has provided home care across the Puget Sound region for decades. Our Apple Health home care program serves Snohomish, Whatcom, Skagit, and Island Counties, and we hold Washington State contracts for Medicaid Personal Care, COPES, and In-Home Respite.
If you are reading this because the news has you worried, the most useful next step is usually a real conversation with a real person who knows the Washington system. We can walk through your loved one’s current services, explain how the 2026 changes do or do not affect them, and help you prepare for the renewal cycle.
Frequently Asked Questions
Will I lose my Apple Health home care on October 1, 2026?
No, not if you are a U.S. citizen, a qualifying lawful permanent resident, a Cuban or Haitian entrant, or a COFA citizen. The October 1 change affects which noncitizen groups are eligible going forward; it does not end home care for the citizens and most green card holders who currently receive Apple Health.
What is the 80/20 Medicaid rule and when does it take effect?
The 80/20 rule is a federal Medicaid policy requiring that at least 80% of payments for personal care, homemaker, and home health aide services go to direct care worker compensation. State reporting begins in 2026, and full compliance is required by 2030.
I am not a U.S. citizen. Will I still qualify for Apple Health home care?
It depends on your specific immigration status. Lawful permanent residents (green card holders), Cuban and Haitian entrants, and COFA citizens remain eligible. Refugees, asylees, humanitarian parolees, and several other categories will lose federal Medicaid eligibility on October 1, 2026. Contact DSHS for case-specific guidance before that date.
Do these changes affect COPES or In-Home Respite?
The Washington programs themselves (COPES, Medicaid Personal Care, and In-Home Respite) remain active in 2026. The federal changes affect eligibility, payment transparency, and future renewal frequency, not the existence of the programs.
Where can I get help in Snohomish, Whatcom, Skagit, or Island County?
Start with your DSHS Home and Community Services case manager if you have one. If you do not, contact Sunrise Services and we will help you understand your options. We have offices and care teams across the four-county area.
Take the Next Step
The Medicaid home care changes 2026 sound bigger than they are for most Washington families already receiving Apple Health home care. Coverage continues. Programs continue. What changes is the paperwork rhythm, eligibility for some noncitizen groups, and the long-term workforce funding model. Use this year to update your information, confirm your renewal date, and ask questions while there is plenty of time.
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