Recently, there's been a cautious question coming up among people around me. They're asking if a family member without proper documentation can no longer apply for the Apple Health Expansion program.

To put it simply, yes, that's correct. The Washington State Health Care Authority (HCA) has announced that new registrations for the Apple Health Expansion are closed.

So today, I'll briefly summarize this disappointing news and calmly explore the remaining options.

First, let's clarify what this program was. It was a state government health insurance program for residents aged 19 and older who couldn't receive regular Apple Health due to their immigration status, and whose income was at or below 138% of the federal poverty level.

Applications opened on June 20, 2024, and coverage began in July of that year.

However, the group aged 19 to 64 reached its capacity the very next day, June 21. I remember being quite surprised when I first saw that news.

According to HCA data, as of November 13, 2024, there were 11,462 people who qualified but were denied due to capacity limits. The numbers show just how high the demand was.

The current situation is even tighter. HCA has stated that they will not open registration for the expansion program while changes under the federal bill (H.R.1) could cause many people to lose their insurance.

Those who are already enrolled continue to receive coverage. However, starting January 1, 2027, due to the state supplemental budget, the managed care system will switch to a fee-for-service model.

If you are enrolled, it's a good idea to check with your current doctor to see if they will continue to provide care under the new system.

So what should those needing new insurance do? The first option is the Washington Healthplanfinder.

The Healthplanfinder informs that anyone can purchase health and dental insurance regardless of their immigration status. This means that even without documentation, enrollment is possible.

While federal subsidies are not available, the state-provided Cascade Care Savings can be received as long as income criteria are met, regardless of immigration status.

The income criteria are set at 250% of the federal poverty level. However, if you are offered affordable insurance through your job, you may be excluded from eligibility.

Timing is also important. The open enrollment for 2027 plans is from November 1, 2026, to January 15, 2027.

If you enroll by December 31, coverage will start on January 1, and if you enroll between January 1 and 15, coverage will begin on February 1. It's a good idea to gather your documents and income information this month to ease your mind.

Additionally, Healthplanfinder indicates that children and pregnant individuals can apply for Apple Health regardless of their immigration status. If you have family members who fall into this category, be sure to check separately.

The second option is charity care from hospitals. Surprisingly, many people are unaware of this.

The Washington State Attorney General's Office states that all patients can apply for charity care regardless of their immigration status.

For tier 1 hospitals, which are part of large hospital systems, those with incomes at or below 300% of the poverty level can have their hospital bills fully waived, and those up to 400% can receive discounts.

For tier 2, which includes small independent hospitals or rural hospitals, those at or below 200% can receive full waivers, and discounts apply up to 300%.

Applications can be made directly at the financial counseling office of the hospital where you received care. The Attorney General's Office has indicated that this also applies to old bills, so don't hesitate to pull out any old statements from your drawer.

The third option is the Alien Emergency Medical program. Those who do not qualify for other Apple Health programs may still be eligible under certain conditions such as emergencies, hospitalization, dialysis, or cancer treatment plans.

According to the HCA guide, you do not need to confirm eligibility before starting emergency treatment. Applications can be made at washingtonconnection.org.

The fourth option is local community health centers. These federally supported centers operate sliding fee scales based on income, allowing for reduced medical costs even without insurance.

If you have ongoing health issues like needing blood pressure or diabetes medication, it's better for both your health and your wallet to establish a primary care physician at one of these centers before heading to the emergency room.

One more change to be aware of is that Healthplanfinder has announced that starting October 1, 2026, the eligibility and benefits for Apple Health for non-citizens will change.

From January 1, 2027, only certain groups, such as lawful permanent residents, will be able to receive federal subsidies. Families of lawful residents without permanent status should also recalculate how premiums will change during this open enrollment period.

Since policies change frequently and outcomes vary by individual circumstances, please consult with your doctor or pharmacist regarding treatment or medication decisions, and verify eligibility directly with HCA or Healthplanfinder.

If I were in your shoes this fall, I would first get a quote for Cascade Care Savings through Healthplanfinder before the November open enrollment, and if I feel unwell, I wouldn't hesitate to ask about charity care at the hospital. One door may have closed, but there are still a few windows open if you look for them.