Apple Health (Medicaid) to 26

Am I eligible for medical coverage after I turn 18 years old?

You may be eligible if you answer “yes” to one of the statements below:

  1. I am currently under age 21 and in foster care or other eligible out-of-home placement with DCYF or a federally recognized tribe within Washington state. (This is known as Extended Foster Care Coverage)
    OR
  2. I am currently under age 26 and I left foster care or other eligible out-of-home placement on or after my 18th birthday. (This is known as Alumni coverage). 

Eligible out-of-home placements include:

  • Licensed foster and relative care
  • Tribal foster care
  • ICPC foster care in Washington state
  • Dependency Guardianships established prior to June 2010
  • Suitable other placements (unlicensed, court ordered)

Note: Youth in the Adoption Support program are eligible until their 18th birthday or up to age 21 if still in high school.

Managed Care or Fee-For-Service?

For Apple Health Alumni coverage you have the option between Apple health managed care or Apple Health coverage without a managed care plan (also known as fee-for-service). 
 
Managed Care:

Apple Health Core Connections (AHCC) administered by Coordinated Care provides essential Washington Apple Health (Medicaid) benefits including physical, behavioral, and dental. AHCC has care managers to help find providers and coordinate your health care needs. For more information visit the Apple Health Core Connections webpage. 

Fee-for-Service:

Apple Health coverage without a managed care plan (also known as fee-for-service) is when Apple Health pays your provider directly. You may choose any provider who participates in the Apple Health fee-for-service program and currently accepts patients. You can locate a provider by visiting HCA Find-a-Provider. For more information regarding covered services visit the Medicaid services webpage. 

For eligibility and enrollment into the AHCC program or fee-for-service, call the Foster Care and Adoption Support (FCAS) team at HCA, 1-800-562-3022 ext. 15480.or email fcas@hca.wa.gov to help you decide what type of coverage is best for you.

What else do I need to know?

  • Keep your contact information like your address or phone number updated by contacting the FCAS team.
  • For Alumni individuals, you can also make changes through Washington Healthplanfinder. Be sure to select email as your preferred choice for notices if you have an email account available. You will receive a notification to check the Washington Healthplanfinder for new notices which helps to avoid losing coverage due to returned mail.
  • You can apply for TANF or Basic Food online or in person at your local DSHS Community Services Office.
  • KEEP your ProviderOne services card and your Managed Care (AHCC) cards when you leave foster care.

What is a ProviderOne services card?

About 7-10 days after you're found eligible for Apple Health coverage, a services card will be mailed to you. This is a plastic ID card that looks similar to other health insurance ID cards. Take this card with you to your doctor appointments. Providers use this card to make sure your service is covered. 

How do I replace my ProviderOne services card? 

There are several ways to request a replacement:

There is no charge for a new card. Your old card will stop working when you ask for a new one. These instructions also work for non-English speaking youth. FCAS uses interpreter services when needed.

Can I view my services card online?

You may access a digital copy of your services card through the WAPlanfinder mobile app. No need to order a replacement when you have a digital copy with you at all times.

What if I lose my AHCC card?

Call 1-844-354-9876 and request a new card or go to www.coordinatedcarehealth.com and use the Online Member Account to get a new ID card 24/7.

There is no cost if you need a new card. Contact Coordinated Care Apple Health Core Connections at 1-844-354-9876 or login to your Member Account (if over 18). Always keep this card and your Provider One Services Card with you. However, you do not need this card in order to receive health care services. If you ever have problems at a doctor’s office or pharmacy, make sure and call Coordinated Care 24/7 so they can help. 1-844-354-9876.

Get the most from Apple Health

You may not know all the helpful benefits and services that are covered by Apple Health.

In addition to all the things you would expect to be covered like doctor office visits, emergency room, lab tests/x-rays, prescriptions, hospital care, there is a whole lot more.

Check out the list below for covered services that can help you be healthier and save you money.

Are you a Coordinated Care Apple Health Core Connections member? Call 1-844-354-9876 for assistance with any of these benefits below.

Dental

Adult Dental Benefits for age 21 and over includes: exams, annual teeth cleaning, x-rays, fillings, extractions and more. Youth under 21 have additional dental benefits. You must go to a Dentist that accepts the ProviderOne Services Card.

Over the Counter Medications with a doctor’s prescription: such as painkillers, antacids, allergy and cold medicines, athlete’s foot cream, diabetic testing supplies, prenatal vitamins and many more.

Help Quitting Smoking

Including no-cost medication (such as gum, lozenges, patch) to help you quit and someone to encourage and support you in the process of quitting smoking.

Family Planning Services

Apple Health covers family planning services including birth control regardless of your sex or gender.

Your Apple Health coverage will cover the cost of your annual exam and chosen birth control method, including:

  • Emergency contraception pills
  • Condoms
  • Birth control pills
  • Vaginal Ring
  • Contraceptive Ring
  • Contraceptive Implant (Implanon)
  • Diaphragm
  • IUD
  • Depo Provera Shot
  • Tubal ligation
  • Vasectomy

If you received Apple Health coverage while pregnant, you are eligible for After-Pregnancy coverage for up to 1 months following the pregnancy.

Transportation to Medical Appointments

Help with no cost rides or gas money to get to and from the doctors, dentist, hospital, and/or drug store for medically necessary services

  •  
    • If eligible, transportation will be provided to services covered by Apple Health.
    • Your Regional Broker will arrange the most appropriate, least costly type of transportation to the closest medical provider offering the service you need.
    • It is best to plan ahead 7-14 days if you want to use this benefit.
  • Contact your Regional Broker for more information and to arrange transportation.

Eye Exams, Eye Glasses, and Contacts

Eye exams, including tests for refraction and visual fields, are provided for children up to 20 years old once every 12 months and for adults 21 and over every 24 months.

For children up to 20 years old, eyeglass frames, lenses, contact lenses, and fitting services are covered by the Provider One Services Card. Your eye doctor will help you get this service. It is a great idea to get glasses/contacts if you need them prior to turning 21 while you still have them as a no-cost benefit!

For adults, eyeglass frames, lenses, and contact lenses are not covered by Apple Health, but if you wish to buy them, you can order them through participating providers at a discounted price. You’ll find a list of participating providers at https://www.hca.wa.gov/assets/free-or-low-cost/optical_providers_adult_medicaid.pdf

Flu Shots

Did you know in recent years the flu has made many young people very sick? Protect yourself and those around you by getting a flu shot every year at no cost. You can get the flu shot at covered pharmacies or from your primary care doctor’s office.

Teladoc

Teladoc is an easy way for Coordinated Care members to talk with a doctor on a computer, tablet or phone.

24-hour access to in-network providers for non-emergency medical issues. Get medical advice, a diagnosis or a prescription.
You can make appointments that work with your schedule. Get help for:

  • Colds, flu, fevers
  • Rash, skin conditions
  • Sinuses, allergies
  • Respiratory infections
  • Behavioral health (18 years and older)

Set up an account so it’s ready when you need it. Visit Teladoc.com/CoordinatedCare or call 1-800-835-2362 (TTY:711). To get started, you need the member’s name, date of birth, and an email address.

Urgent Care or Emergency Room

If your problem is not an emergency, you may wait a long time in the ER. Instead of going to the ER for something that is not life-threatening, call your doctor or go to an urgent care clinic.

For Coordinated Care Apple Health Core Connections members, you can call your doctor or call 24/7 the Nurse Advice Line for help on what to do. They can assist with medical and mental health questions. You may be advised to go to an Urgent Care Center. To find the nearest Urgent Care Center call the Coordinated Care Nurse Advice Line at 1-844-354-9876 or use the Find A Doctor tool.

If you feel your life is in serious medical danger, you should call 911 or go to an Emergency Room (ER). ERs are open 24 hours a day. They provide immediate, emergency medical care. Some reasons to go to an ER or call 911 right away include:

  • Chest pain or other severe pain
  • Fainting/unconsciousness
  • Suddenly not able to see, move or
  • Miscarriage/pregnancy with vaginal bleeding
  • A bad burn
  • You are in labor
  • Seizures
  • Drug overdose
  • Bleeding that won’t stop
  • Gun or knife wounds
  • A broken bone
  • Poisoning 

No Health Care Bills!

On Apple Health you should never get a bill for covered health care services. There is never any co-pays or fees for the services provided with Apple Health. If you get a bill, don’t panic! Contact FCAS or your health plan. If you are a Coordinated Care Apple Health Core Connections Member, contact 1-844-354-9876 if you receive a bill and they will do the work to get it fixed for you.

Behavioral Healthcare

A behavioral health condition, also called a mental health issue, causes changes in a person’s thinking, mood or behavior. This includes problems like:

  • Feeling sad or hopeless
  • Depression
  • Anxiety
  • Drug and alcohol abuse
  • ADHD

Many mental health issues are medical problems, just like cancer or heart disease. These can happen to anyone. They can be treated. Treatment may include talking to a therapist or taking medication. Left alone, mental health problems can get worse.

You can get counseling, outpatient treatments, office visits for behavioral health issues, medications, inpatient behavioral health services, intensive behavioral health services and substance abuse treatments as part of your Apple Health benefits.

If you are a Coordinated Care Apple Health Core Connections Member, call 1-844-354-9876 to talk with a behavioral health care coordinator to get help with behavioral health services.

Receive anonymous, confidential support by teens for teens by calling 866-TEEN-LINK or online chat. The helpline is open 6 p.m. to 10 p.m. 365 days a year.

Extra Programs for Coordinated Care Apple Health Core Connections Members

Start Smart for Baby

Start Smart for Your Baby (Start Smart) is our special program for people who are pregnant and for those parents who just had a baby. We want to help you take care of yourself and your baby every step of the way. If you are pregnant, please let us know by calling us at -877-644-4613 (TDD/TTY 1-866-862-9380). Or you can log in to your Coordinated Care account and fill out the Notification of Pregnancy form. You are automatically enrolled into Start Smart for Your Baby® when you complete the Notice of Pregnancy (NOP) form (this form must be completed at least 6 weeks before your due date to qualify for a car seat). This program includes extras like:

  • No Cost Car Seat: Sent to the member when you tell us you’re pregnant! (Must complete NOP form as stated above)
  • Breastfeeding Support: Includes a no-cost, high-quality breast pump for moms who are nursing. 

Rewards Program

We want to help you have good health. Coordinated Care gives you rewards for taking care of your health. Through the Rewards Program, you can earn reward dollars on a pre-paid gift card. There are no fees or costs to you. It’s our way of celebrating your choice for better health. Earn rewards by doing healthy activities like getting your annual wellness exam. After you complete one of the healthy activities, we automatically mail a Rewards VISA Pre-paid card to you. You can use your card to buy hundreds of items like groceries, baby care or personal care products at participating stores. Visit our website to learn more and see a list of items available to purchase.

Cell Phone Program

A cell phone at no cost is made available to qualifying members through SafeLink®, a federally funded phone program. Coordinated Care members get a smart phone, 3 GB of data, 350 minutes per month and unlimited texting. In addition, calls to our Member Services line or 24/7 Nurse Advice Line do not count towards your minutes.

Care Management

Receive personalized assistance getting social services and accessing your health plan benefits. Our team of Community Health Workers (CHWs) is part of the Care & Disease Management department.