New changes to Apple Health—Washington's Medicaid program—mean many people in the Upper Valley and beyond may lose their healthcare. Even for those who don't, there are new program requirements that may be hard to navigate.
Starting September 30, 2026, people who get their health insurance through Apple Health, Washington’s Medicaid program, started seeing changes to their coverage. Based on new parameters, some people may lose their insurance altogether, including people in the Upper Valley.
Liz Hazen, MEND’s social worker, says the changes in insurance will cause a squeeze across MEND’s programs. She anticipates a rise in people using the Free Clinic, and more people using the food pantry and applying for financial assistance because they need the money for medical costs.
“Changes happening across our country are impacting our neighbors, which has led to a lot of sadness and hopelessness with the people I see,” says Liz. “Sometimes it’s hard to find the words to encourage them.”
Some of the more significant changes to Apple Health are outlined below.
New work requirements take effect January 1, 2027
One of the biggest changes is a work requirement for anyone who still qualifies for Apple Health. Unless someone has received an exemption, they must either work or volunteer—or some combination of the two—for 80 hours a month. Alternatively, they can get an exemption to the work requirement if they can show they make at least $580 a month—about 34 hours if they earn Washington State’s minimum wage.
Insurance renewals will now occur twice a year, starting the next time the person has to renew
When a person’s health insurance is up for renewal, they need to verify that they still qualify for the program. Renewals for Apple Health will happen every six months instead of once a year. Households that earn more than 138% of the federal poverty level don’t qualify for Apple Health. The federal poverty level is adjusted according to the number of people in the home. For example, a single person must make less than $22,025 a year to qualify for free medical insurance. For two people, it’s $29,863; for a family of four, it’s $45,540.
People who are no longer eligible for Apple Health starting September 30, 2026
After September 30, 2026, the following people will no longer be eligible for Apple Health:
Asylees
Conditional entrants
Refugees
Individuals for whom deportation and removal have been withheld—people the U.S. government cannot legally send back to their home country because their life would be threatened
Victims of trafficking
Violence Against Women Act self-petitioners
People on parole
Exceptions to Apple Health’s new requirements
Among the groups that will lose their Apple Health coverage, there are a number of exceptions. People who qualify for these exceptions will continue to have access to free medical insurance through other state insurance programs:
Anyone under 19
Anyone pregnant or postpartum (up to a year after the birth of the child)
Anyone with an emergency medical condition (coverage limited to the condition itself)
Anyone receiving Aged, Blind or Disabled (ABD) cash assistance
For people who no longer qualify for Apple Health or one of the above programs, Washington State is offering alternative insurance plans through Washington Health Plan Finder, the state’s insurance exchange. There will be a 60-day special enrollment period available for anyone who has lost coverage. Plan costs are adjusted based on the person’s income level and eligibility status but may not be free like Apple Health.
Chaos and confusion
There is a lot of confusion and apprehension about the changes—both among the people who need the services and those who support them.
“Yes, it’s true that people can qualify for exceptions,” says Liz. “But the process can be complicated. For someone who is experiencing homelessness or struggling with mental health challenges, navigating that process can be an unrealistic option."
One of the biggest concerns is people losing their insurance because they either didn’t receive the information or didn’t understand it. The system will try to automatically renew a person’s health insurance first. If their income and other information can’t be verified, they’ll send a letter asking the person to update their information through the online portal. If that notification is returned to sender, the person will lose their insurance. People who don’t have an income or their income doesn’t appear in the state’s wage data are most likely to receive a letter, including people who don’t receive a regular paycheck.
For many people who don’t have addresses, they may not receive the information at all, only discovering they’ve lost their insurance when they go to use it. Although unhoused people used to be able to receive information about their health insurance via general delivery at local post offices, that option is no longer allowed. Service organizations are trying to figure out the best way to keep those clients from losing coverage.
MEND is bracing for the impact of these changes. Thank you for helping to meet the growing needs in the Upper Valley—it would not be possible without your support.