The health care coverage and access landscape is facing one of its most significant shifts in a decade, and here in King County, a mighty team of health insurance experts have been preparing for the impacts.
As King County’s Lead Navigator Organization, Public Health’s Access & Outreach program works with state agencies, health care providers, and community partners to help residents maintain access to health coverage and care, including finding solutions for people impacted by changes to coverage eligibility or enrollment.
While adjustments and updates to Medicaid year to year aren’t completely uncommon, the changes beginning in late 2026 and continuing into 2027 and beyond are the most complex we’ve faced in recent years. So, what prompted this major shift?
Just over a year ago, Congress passed H.R. 1, a bill resulting in significant new requirements to qualify, requalify, and retain Medicaid and Qualified Health Plans (QHP). Since then, the Access & Outreach team has been working to decipher new requirements as they are developed, coordinate with partners across the health care system in Washington State, and ensure that impacted communities have the information and support they need to prepare and find a path to health care coverage.
We sat down with Daphne Pie, Regional Health Administrator for Public Health – Seattle & King County’s Access & Outreach program, to talk about what’s ahead, how King County is preparing, and what you can do if you or your family, community, or clients might be impacted.
What is Apple Health?
Apple Health is Washington State’s name for Medicaid and serves as the umbrella for many different Medicaid programs. Under Apple Health, there are a variety of programs that people may be eligible for based on their individual circumstances and identities.
What’s changing and who will this affect?
There are two groups these changes will impact over the next six months; some non-citizens 19 years and older who may no longer be eligible for coverage through Apple Health, and adults ages 19-64 who will need to undergo stricter re-certification for their plans to remain eligible. Here’s how it breaks down:
Non-citizens
Starting October 1st of this year, some non-citizens who are 19 and older who currently qualify for Apple Health will no longer be eligible. When we say non-citizens, we are talking about individuals who are here legally, such as refugees, asylees, or another approved non-citizen. This includes individuals for whom deportation or removal has been withheld.
Public Health and our partners are helping people in King County with Medicaid/Apple Health to either stay enrolled or find alternative resources that can help them access the health care they deserve.
For refugees or asylees, they may not lose coverage if:
- Their status has changed, e.g. if they now have Green Card status (permanent resident card).
- There are other programs people may be eligible for. That’s why it’s important to explore if people have medical or other conditions that will qualify them for continued Apple Health insurance.
- If someone is pregnant or has been pregnant in the last year, they may still be eligible for coverage.
- If they don’t qualify for these other programs, then we will help them look up costs for a qualified health plan.
We work with each person individually, to see what they may be eligible for. We are working closely with navigators, hospitals and community-based organizations to identify clients now who may be at risk of losing insurance, and find options, so they don’t have interruptions in their health coverage.
Adults ages 19-64
Beginning January 1, 2027, adults ages 19-64 will be required to:
- Renew eligibility every 6 months or risk losing coverage.
- Meet work requirements to receive coverage, which can include: earning $580/month; being a student at least half-time; participating in a work program; completing 80 hours/month of community service or training; or community engagement for 80 hours/month.
- While exemptions to these requirements are still being finalized, some examples will include circumstances that prevent someone from meeting the work, school, or service requirements. This could include being a caregiver, having a serious medical condition, and more.
- Throughout the 2027 calendar year, individuals will be able to self-verify that they meet any of the requirements or an exemption. However, by 2028, they will need to provide official documentation.
- Retroactive coverage will also be reduced, adults 19-64 reduced from 3 months to 2 months and children, pregnant women and other Apple Health programs reduced from 3 months to 1 month.
For individuals, we want to help look in advance to see if anyone has an exemption before a client gets a letter on work requirements. We know this gets complicated – so we hope people will contact a navigator for help.
The good thing? We have a couple months to get all the information from the Healthcare Authority and understand the exemptions. This week (August 28, 2026), hundreds of health insurance navigators and advocates are meeting at First Friday Forum, a space hosted monthly by the Access & Outreach team. This month will focus on an extended training to prepare for the upcoming changes to Apple Health for adults. First Friday For is open to any community-based organization, government agency, hospital, outreach organization, or individual interested in building partnerships, strengthening community collaboration, and learning more about publicly sponsored programs and available resources.
For more details and to register for this event online visit: August 28, 2026, First Friday Forum
Where else can people learn more?
We don’t want a situation where come October 1st or later, someone doesn’t have medication or treatment because they lose their coverage or aren’t properly prepared to meet the work requirements to keep coverage active, even if they qualify. That’s why we want to continue to share information and make sure people are connected with a navigator, community-based organization, or us here at Public Health who can help them navigate options.
To learn more, find information you can share with your community, or seek help, please visit kingcounty.gov/coverage/HR1. You can also email or call our free and confidential Community Health Access Program (CHAP) line at CHAP@kingcounty.gov or 1-800-756-5437.
All details shared in this blog are based on the latest information we have as of August 25, 2026.
Originally posted 8/25/26