Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against Washington State Health Care Authority (HCA) and Medicaid.gov guidelines | Last Updated: June 2026
The Washington Medicaid fee schedule for 2026 has been updated by the Washington State Health Care Authority (HCA), with new rates effective January 1, 2026.
These updates affect how providers are paid for services under Apple Health, Washington’s Medicaid program.
This article explains what changed, where to find official rate files, and what providers and patients need to know.
Quick Summary:
- Apple Health (Washington Medicaid) fee schedules were updated effective January 1, 2026
- The HCA manages all fee schedules; rates are published as downloadable Excel or PDF files by provider type
- A mid-year update is planned for July 1, 2026 under State Plan Amendment 26-0015
- Physician-related services, medical equipment, and telemedicine all received 2026 updates
- Starting October 1, 2026, Apple Health eligibility expands to include certain noncitizen adults
- To check if you qualify for Apple Health, use our free Medicaid Eligibility tool
What Is Washington Apple Health (Medicaid)?
Washington calls its Medicaid program Apple Health. It provides free or low-cost health coverage to eligible Washington residents, including adults, children, pregnant women, seniors, and people with disabilities.
The program is run by the Washington State Health Care Authority (HCA) and funded jointly by the state and federal government.
Apple Health covers doctor visits, hospital care, prescriptions, mental health services, and more. Providers who serve Apple Health patients are paid according to official fee schedules published by the HCA.
Who Runs Apple Health?
The Washington State Health Care Authority (HCA) administers Apple Health. The HCA sets payment rates, publishes billing guides, and manages provider enrollment. All official fee schedules come from the HCA — not from insurance companies or third-party sources.
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule is a list of approved payment rates. It tells healthcare providers exactly how much Apple Health will pay for each service. Rates are listed by billing code (CPT or HCPCS). Providers must bill using these codes and cannot charge more than the approved rate.
Who Qualifies for Washington Apple Health (Medicaid) in 2026?
Washington Apple Health covers several groups of residents. To qualify, you must live in Washington State and meet income and other eligibility rules. Understanding Medicaid Eligibility in Washington is the first step to getting covered.
Eligibility is based on your household size, income, age, and immigration status. Most applicants use Modified Adjusted Gross Income (MAGI) rules to determine eligibility. Some groups — like seniors and people with disabilities — use different rules that may include asset limits.
Eligibility Groups for Apple Health 2026
| Category | Who Qualifies |
|---|---|
| Adults (19–64) | Low-income adults under the ACA Medicaid expansion |
| Children | Children under 19 with qualifying household income |
| Pregnant Women | Pregnant residents meeting income limits |
| Seniors (65+) | Adults 65+ meeting income and asset rules |
| People with Disabilities | SSI recipients and others with qualifying disabilities |
| Noncitizen Adults (Oct 2026) | Certain noncitizens newly eligible starting October 1, 2026 |
New Eligibility Expansion in October 2026
Starting October 1, 2026, Apple Health will expand to cover certain noncitizen adults who were previously not eligible. This change is expected to increase the number of Apple Health enrollees across Washington State. Providers should prepare for higher patient volume in the final quarter of 2026.
Washington Apple Health Income Limits 2026
Apple Health income limits are based on the Federal Poverty Level (FPL). Your countable income must fall below the limit for your household size and program type. For a full breakdown of how Washington compares to other states, see our guide on Medicaid income limits by state in 2026.
Most adults qualify for Apple Health if their income is at or below 138% of the FPL under the ACA Medicaid expansion. Other programs — like long-term care — use different income thresholds.
Apple Health Income Limits by Household Size (ACA Expansion, 2026)
| Household Size | Monthly Income Limit (138% FPL) | Annual Income Limit |
|---|---|---|
| 1 | ~$1,732/month | ~$20,782/year |
| 2 | ~$2,344/month | ~$28,124/year |
| 3 | ~$2,957/month | ~$35,482/year |
| 4 | ~$3,569/month | ~$42,831/year |
| 5 | ~$4,182/month | ~$50,180/year |
Source: Medicaid.gov, based on 2026 Federal Poverty Level guidelines.
Income Limits for Aged, Blind, and Disabled (ABD) Medicaid
For Washington residents who are aged, blind, or disabled, different income limits apply:
- Regular (ABD) Medicaid: $994/month for a single individual
- Institutional / Nursing Home Medicaid: $2,982/month for a single individual
These figures are verified for 2026 per Medicaid Planning Assistance and Washington HCA standards. Asset limits also apply to this group. Income types like SSI payments and certain disability benefits may be treated as exempt income under state rules.
Washington Medicaid Fee Schedule 2026: Key Updates
The Washington HCA released updated fee schedules effective January 1, 2026, as part of State Plan Amendment (SPA) 26-0002.
This routine, budget-neutral update aligns billing codes and payment rates with CMS, state policy, and coding changes for the new calendar year.
For a national overview of how states are adjusting rates this year, visit our guide to the Medicaid Fee Schedule 2026.
Fee schedules in Washington are not published as one single list. Instead, the HCA publishes separate downloadable files for each provider type. These files are in Excel or PDF format and are updated throughout the year.
Where to Find Official 2026 Fee Schedules
The only verified source for Washington Apple Health fee schedules is the Washington State Health Care Authority website.
- Official link: Provider billing guides and fee schedules — HCA
- How to search: Filter by “Program/Topic” (e.g., Physician-related services, Dental, Vision) to find files effective January 1, 2026, or later
- Files are available as Excel spreadsheets or PDF documents
- Look for columns labeled “Rate” or “Maximum Allowable Fee” for specific payment amounts
Do not rely on third-party websites for payment rates. Always download directly from the HCA.
Physician-Related and Professional Services
The Physician-Related / Professional Services fee schedule is the largest and most widely used. It covers most standard CPT and HCPCS billing codes for doctors, nurse practitioners, and other licensed practitioners.
- Effective Date: January 1, 2026
- This schedule is updated annually to align with new CPT codes and Medicare adjustments
- Washington Medicaid uses a Resource-Based Relative Value Scale (RBRVS) similar to Medicare
- Important: Do not assume Washington Medicaid rates match Medicare exactly. Always verify the specific “Maximum Allowable Fee” in the HCA Excel file
A note on the “2.93% update” claim: Some search results mention a 2.93% update for the 2026 Physician Fee Schedule. This figure typically refers to federal Medicare adjustments or historical 2024 data that has been mislabeled. It does not reflect a confirmed Washington Medicaid conversion factor. Always use the HCA’s official Excel files for accurate rates.
Medical Equipment and Supplies
The Medical Equipment & Supplies fee schedule was updated multiple times in early 2026. This is one of the most frequently revised schedules under Apple Health.
| Update Date | Notes |
|---|---|
| January 1, 2026 | Base annual update |
| February 10, 2026 | Mid-cycle revision |
| April 9, 2026 | Most recent confirmed update |
Providers billing for durable medical equipment (DME) should always use the most recently updated file. The April 9, 2026 version is the current effective schedule as of this writing.
Telemedicine Fee Schedule 2026
Washington Apple Health has a dedicated Telemedicine Policy and Billing Guide in effect for 2026. This guide outlines which audio-visual and audio-only services are reimbursable under Medicaid.
- Effective Date: January 1, 2026
- Covers both synchronous (live video) and audio-only telehealth visits
- Reimbursement rates for telemedicine codes are listed within the standard physician fee schedule and the telemedicine billing guide
- Providers must follow HCA documentation requirements to qualify for telemedicine reimbursement
Planned Mid-Year Update: July 1, 2026
The HCA has a scheduled Fee Schedule Effective Date Update under State Plan Amendment 26-0015, planned for July 1, 2026. This mid-year adjustment typically addresses rate changes for specific programs or provider types. Details will be published on the HCA website when the SPA is finalized.
Providers should check the HCA website again after July 1, 2026 to confirm whether their billing codes or rates have changed.
Confirmed 2026 State Plan Amendments (SPAs)
Washington State filed formal notices with CMS to document its 2026 Medicaid rate changes. These documents are the official legal record of fee schedule updates.
The SPA process ensures federal oversight of state Medicaid payment changes. Budget-neutral updates like SPA 26-0002 do not require federal approval for spending increases but must still be filed and accepted by CMS.
SPA 26-0002: January 2026 Fee Schedule Update
- Filed by: Washington State Health Care Authority
- Effective Date: January 1, 2026
- Description: Routine, budget-neutral update to keep rates and billing codes aligned with CMS, state, and other coding/coverage changes
- Official Document: lawfilesext.leg.wa.gov — SPA 26-0002
CMS-Approved Washington Fee Schedule for 2026
CMS has confirmed a Washington Medicaid fee schedule approval covering the rating period January 1, 2026 through December 31, 2026 for a provider class labeled “Other.” This approval relates to publicly funded sexual and reproductive health family planning providers and was incorporated into capitation rates through a risk-based rate adjustment.
- CMS Record: medicaid.gov/state-resources/2026-01-12/188301
- SPA Document: medicaid.gov/medicaid/spa/downloads/WA-26-0002.pdf
What Does Apple Health (Washington Medicaid) Cover?
Apple Health covers a wide range of health services for eligible Washington residents. Coverage varies slightly depending on your eligibility group and whether you receive care through managed care or fee-for-service.
Most Apple Health members receive care through a managed care organization (MCO). The MCO contracts with the HCA and is reimbursed through capitation rates — a set monthly payment per member — rather than individual fee-for-service payments.
Covered Services Under Apple Health 2026
- Doctor visits and specialist care
- Hospital stays (inpatient and outpatient)
- Prescription drugs
- Mental health and substance use treatment
- Dental care (adults and children)
- Vision care
- Pregnancy and maternity care
- Preventive care and immunizations
- Durable medical equipment (DME)
- Telemedicine (audio-visual and audio-only)
- Home health and long-term care (for eligible members)
- CHIP (Children’s Health Insurance Program) for children in higher-income households
Services with Special Billing Rules
Some services require prior authorization before they are covered. Providers must get approval from the HCA or the managed care plan before delivering these services. Examples include:
- Certain surgeries and procedures
- High-cost medications
- Long-term residential care
- Some specialty referrals
Always check the relevant billing guide for prior authorization requirements by service type.
How to Apply for Apple Health (Washington Medicaid) in 2026
Applying for Apple Health is free. Washington residents can apply online, by phone, by mail, or in person. There is no enrollment period — you can apply at any time of year.
Your coverage may start on the date you apply or even earlier if you qualify for retroactive coverage. The HCA determines your eligibility determination based on your application and any documents you submit.
Steps to Apply for Apple Health
- Check your eligibility — Review income limits for your household size and eligibility group
- Gather documents — You may need proof of income, identity, Washington residency, and immigration status
- Apply online — Visit Washington Healthplanfinder to start your application
- Apply by phone — Call 1-855-923-4633 (Washington Healthplanfinder customer support)
- Apply in person — Visit your local Community Services Office (CSO) or DSHS office
- Apply by mail — Download and mail the paper application to your local DSHS office
- Wait for your eligibility determination — The HCA typically processes applications within 45 days (or 90 days for disability-based cases)
- Receive your Apple Health card — Once approved, you will receive a Medicaid card and can begin using your coverage
What Happens After You Apply?
After you submit your Apple Health application, the HCA reviews your information to confirm eligibility. You may be asked to provide additional documents. Keep copies of everything you submit.
If approved, your coverage start date may be the first day of the month you applied or earlier if you qualify for retroactive Medicaid. Retroactive coverage can cover bills from up to three months before your application date if you were eligible during that time.
Application Timeline
| Stage | Typical Timeline |
|---|---|
| Application submitted | Day 1 |
| HCA processes application | Up to 45 days (standard) |
| Disability-based cases | Up to 90 days |
| Approval notice mailed | Within a few days of decision |
| Medicaid card received | Within 7–14 days of approval |
| First appointment eligible | After coverage start date |
Renewal of Apple Health Coverage
Apple Health coverage must be renewed annually. The HCA will send you a renewal notice before your coverage expires. You must confirm your information or provide updates to keep your coverage active. Missing your renewal deadline can cause a gap in coverage.
If your income or household situation changes during the year, report it to the HCA as soon as possible. Changes may affect your eligibility or your enrollment period for a specific plan.
Frequently Asked Questions (FAQ)
Q: What is the Washington Medicaid fee schedule for 2026?
A: Washington Apple Health fee schedules for 2026 are published by the Washington State Health Care Authority (HCA) as downloadable Excel or PDF files by provider type. The January 1, 2026 update (SPA 26-0002) was a routine, budget-neutral revision. There is no single statewide rate book — providers must download the file for their specific program type from the HCA website.
Q: Where can I find the official 2026 Apple Health fee schedule?
A: The only verified source is the Washington State Health Care Authority website at hca.wa.gov. Filter by program type (e.g., Physician-related services, Dental, Vision) to find the correct 2026 file. Always check the “Rate” or “Maximum Allowable Fee” column in the official HCA Excel file.
Q: What are the Apple Health income limits for 2026?
A: For most adults under ACA expansion, the income limit is about $1,732/month for a single person (138% of the Federal Poverty Level). For Aged, Blind, or Disabled (ABD) Medicaid, the limit is $994/month for an individual. Nursing home and waiver programs allow up to $2,982/month. Limits increase with household size.
Q: Does Apple Health cover dental in 2026?
A: Yes. Apple Health covers dental services for both adults and children in 2026. Adult dental coverage includes preventive care, fillings, extractions, and some restorative services. Children receive full dental benefits through Apple Health or CHIP. Coverage details depend on your eligibility group and managed care plan. Check with your provider about prior authorization requirements.
Q: How long does it take to get approved for Apple Health?
A: Most applications are processed within 45 days. If you are applying based on a disability, it may take up to 90 days. Once approved, you will receive a notice by mail followed by your Medicaid card within 7–14 days. Coverage may begin on the date you applied or earlier under retroactive eligibility rules.
Q: Is there a mid-year fee schedule update for Washington Medicaid in 2026?
A: Yes. The HCA has a planned fee schedule update under State Plan Amendment 26-0015, scheduled for July 1, 2026. This mid-year update typically addresses rate changes for specific programs or provider types. Providers should check the HCA website after July 1 to see if their rates or codes were affected.
Sources & Disclaimer
Sources:
- Washington State Health Care Authority — Provider billing guides and fee schedules: hca.wa.gov
- CMS — Washington Medicaid SPA 26-0002 approval: medicaid.gov/state-resources/2026-01-12/188301
- Washington State Register — SPA 26-0002 notice: lawfilesext.leg.wa.gov
- Medicaid.gov — Washington SPA document WA-26-0002: medicaid.gov/medicaid/spa/downloads/WA-26-0002.pdf
- Washington Healthplanfinder: wahealthplanfinder.org
Last Updated: June 2026
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility determinations and verified fee schedule data, contact the Washington State Health Care Authority or visit Medicaid.gov.
