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Apple Wellness for Kids:
Details for Professionals

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"Washington Apple Health for Kids" is affordable wellness insurance offered by the Department of Social and Health Services (DSHS) for children in Washington State.

Apple Wellness for Kids provides medical, dental, vision and mental health benefits to children under age 19 through the Medicaid and S-Bit programs. There are no deductibles or co-pays. The insurance is free or low cost depending on a family'southward gross monthly income and is available to both denizen and non-citizen children.

Eligibility

The eligibility guidelines for Apple tree Health for Kids are based on family unit size and gross monthly income. A pregnancy is included every bit part of the household size – for example, a significant woman with a 4 twelvemonth old child would be a "family of 3". The state takes the following deductions before applying a family's monthly income to the eligibility guidelines:

$ninety per working adult
Childcare expenses (both parents demand to be working and/or in school to get this deduction)
Court ordered child support paid out to a child not living in the home.

Review the eligibility work canvass for the Apple Health for Kids and other DSHS medical programs

Eligibility Summary for DSHS Medical Programs

Income Tabular array

Family unit Size	Monthly income limit for free coverage	Monthly income limit for low-toll coverage ($20 per child)	Monthly income limit for depression-cost coverage ($30 per child)
one	$1,815	$2,269	$2,723
two	$2,452	$3,065	$3,678
three	$3,089	$3,861	$4,633
4	$three,725	$four,657	$5,588
v	$four,362	$5,453	$6,543
6	$4,999	$6,248	$seven,498
7	$5,635	$7,044	$eight,453
8	$vi,272	$seven,840	$nine,408
ix	$6,909	$eight,636	$x,363
10	$7,545	$ix,432	$11,318
11+	$637 each	$796 each	$955 each

Income Guidelines effective April 1, 2011

Free and low-cost coverage – what are the differences?

Benefits for children are the same in both programs. In the land'due south low-cost children's health insurance program (too known as Southward-Scrap) families pay monthly premiums and have different requirements around retroactive and secondary coverage.

Gratuitous insurance (Children's Medicaid)

Eligibility is at or below 200% FPL
Coverage tin can be retroactive – up to 90 days prior to the get-go day of the month in which the state receives the awarding. Unpaid medical bills may be covered if the family is income-eligible at the fourth dimension the neb was accrued and the service is covered. They volition also encompass medical bills accrued between the time of awarding and the official approval. Annotation : the country will Not reimburse individuals only providers that accept DSHS coverage.
Tin be used as secondary insurance to embrace co-pays or services not covered by the chief insurance plan

Depression-price insurance
(State Children's Health Insurance Program or S-CHIP)

Eligibility is betwixt 201-300% FPL
- Betwixt 201-250%FPL: monthly premium is $20/ per child with a maximum of $40/month
- Between 251-300% FPL; monthly premium is $30/ per child with a maximum of $sixty/month
Coverage is retroactive to the 1st of the calendar month the state received the application. Unpaid medical bills may exist covered if the service is a covered expense and the kid was non covered by other health insurance. Annotation: the land will NOT reimburse individuals only providers that accept DSHS coverage.
Families cannot maintain other health insurance for their children which covers doctor, infirmary, x-ray and lab services and enroll in S-CHIP
- Families must accept an stop date to private coverage to enroll, but they may apply for the programme before their coverage actually ends.
- Families may be subject to a four month waiting menstruation afterward employer sponsored insurance ends if the price is less than 2.5% of their countable income. Telephone call the Apple Wellness for Kids Hotline (1-877-543-7669) for more data.

Oftentimes Asked Questions – Applying for Benefits

How do I help a client with verification of income?
When does a customer need to show citizenship and identity?
How practise I address a unique living situation with my clients?
Where exercise I check on the status of an application my client submitted?

Frequently Asked Questions – Understanding Benefits

What is Healthy Options?
What is Fee for Service?
Where does my customer ship the S-CHIP payment?
What is the Premium Payment Program?

How practice I aid a client with verification of income?

For almost programs, including the medical coupon, food stamps, and WIC, you only demand to provide verification of income for the last 30 days, such every bit pay stubs or a signed letter from the employer which states the monthly pay.

What if my customer is self-employed?
- Cocky-employed workers have 2 main options for verifying their income:
  (a) If their income has been consistent since last year, they can submit their Schedule C (form 1040) from last twelvemonth'due south taxation render.
  (b) If they are newly cocky-employed, or their income is different from terminal year, they can take an accountant ready a turn a profit-loss statement. If they practice not utilize an auditor, they themselves tin produce the profit loss statement, simply must verify all the numbers (each turn a profit, each expense) with copies of receipts, invoices, checks, etc.
- You lot can use the Cocky-Employment Income Report as an idea for what DSHS expects from a profit-loss statement, though many businesses will have to make their ain version to lucifer their own particular kinds of profits and expenses.

What if my client's income varies from calendar month to month or is seasonal?
- For many people, such as farm workers, construction workers, fisherman, or those who are self-employed, income may vary from week to week or from month to month. In this case the client can give more than i month'due south income verification to show an overall average. For example, the client could submit copies for three months worth of pay-stubs, or if she is cocky-employed, a profit-loss statement for 3 months.
- For a self-employed client, if she does non use an accountant for this profit-loss statement, she would still demand to verify all the profits and losses with receipts, invoices, checks, etc. It tin can be a claiming to fix this documentation for iii, six, or even twelve months, just it may exist necessary to show that on boilerplate, the client is under the income guideline.

When does a client need to prove citizenship and identity?

The Department of Social and Health Services (DSHS) no longer requires U.Due south. citizens to show proof of citizenship and identity when applying for DSHS programs. Just, clients must provide a valid Social Security Number (SSN). DSHS will follow upwards with the client to verify citizenship and identity if a problem arises with the SSN.

Non U.Southward. citizens must proceed to verify their alien/residency status to receive benefits. For more data, Read the DSHS Alphabetic character

How do I accost a unique living situation with my clients?

Children's Medical Benefits – Children non living with their biological or legally adoptive parents should merely provide proof of their personal income. Their parent's income volition non be counted towards their eligibility. This includes children who live with a family fellow member who is not their legally adoptive parent. The family fellow member's income will not be taken into consideration for the child's eligibility.

Where do I check on the status of an application my
client submitted?

Clients should call the DSHS Customer Service Center
1-877-501-2233
Mon–Friday 8am-5pm

The best time to call is early in the day. When calling DSHS, follow these steps to reach the section you need.

What is Salubrious Options?

Healthy Options is the proper noun for the Country'southward managed care plans. Managed Care refers to access to health intendance through a main intendance provider (usually a Family unit Practitioner, Pediatrician or Internist). This provider is a "gatekeeper" and provides all bones and preventive wellness care and can refer the person to other health services as needed.

What is Fee for Service?

Fee for Service is when a client does not enroll into a Healthy Options managed care programme. Fee for Service is likewise known as an "open up coupon". These clients discover a dispensary or provider who accepts medical coupons and will bill Medicaid for the wellness services provided. Fee for Service is typically an option for clients in counties where at that place are few or no Managed Care Plans Available or for children with special health care needs who see a variety of specialists.

Where does my customer send the Due south-Flake payment?

Monthly payments for the State Children'southward Health Insurance Program (S-CHIP) should be mailed to:

DSHS, FSA
PO Box 9501
Olympia, WA 98507-9501

What is the Premium Payment Program?

The Premium Payment Programme helps families keep private insurance while on Medicaid. If eligible, this DSHS program will pay for health insurance premiums for clients that are already enrolled in the Medicaid Program. Please note – not every family/client already enrolled in Medicaid will automatically authorize.

If you lot tin can reply YES to the following two questions, you might be eligible.

Does at least ane person in your family receive Medicaid? (as well called the medical coupon)
Do you have access to wellness insurance such every bit:
- Private wellness insurance you buy yourself
- Employer sponsored insurance fabricated available through your job
- COBRA continuing your job's health insurance if you become unemployed
- Medicare Supplement

Learn more information virtually the Premium Payment Program

Multilingual Outreach Materials

Apple Health for Kids Flyer

This Seattle-King County Public Wellness flyer is available in 13 different languages. It features information about Washington's free and low cost health insurance for children under historic period 19. The flyers formatted in Word can be customized with your program information, but please get out the 3 logos on the lesser of the page.

Apple tree Wellness for Kids Flyer

Gratis materials from WithinReach

Search for outreach materials that promote health insurance and nutrient resources for children and families in Washington.

Lodge FREE materials from WithinReach