According to Gov. Bob Ferguson’s office, more than 200,000 Washingtonians are estimated to lose their healthcare coverage on Apple Health and Medicaid by the end of next year.
This amounts to 22% of Washington Medicaid enrollees, an enormous number that will touch residents in every corner of our state.
The culprit is easy to find: HR 1, the destructive budget law passed by President Donald Trump and Congress last year. As The Seattle Times reported, HR 1 “cuts more than $1.3 trillion in healthcare and food assistance nationwide,” while making it increasingly difficult to both enroll and keep enrollment in Medicaid nationwide. These Medicaid coverage losses will have a disproportionate impact on communities that already grapple with health inequities.
Without health insurance through Apple Health and Medicaid, people will seek healthcare more rarely, and many will stop seeking it altogether. This means missed diagnoses, lapsed prescriptions and overall worsening health outcomes. People will end up in urgent care and emergency rooms when their situations turn dire, and many will die.
The first wave of changes landed Thursday, when new limits on who counts as a “qualified noncitizen” took effect. Thousands of disenrollment letters have already been mailed out. But Oct. 1 wasn’t the finish line. A second, larger wave hits Jan. 1, 2027, when work requirements and twice-a-year renewals begin for Apple Health for Adults. The journey ahead extends far beyond Jan. 1. The sustained strain on our system won’t show up all at once. It will show up every six months, as people cycle through recertification. That is when the rubber will meet the road.
Some people will lose coverage because they don’t meet the criteria for exemption from the work requirement, or they do not meet the work requirement. Some will lose it because of the administrative burden of proving eligibility (such as not knowing what the documentation requirement is, not being able to get the required documentation or not being able to go through the process every six months). Others will get mistakenly knocked off and cannot withstand the process of appealing. And some are too afraid of the system to even try.
At HealthierHere, we provide dedicated case management to help residents access health insurance and the medical care that follows, along with numerous other essential services. Ours is a “no wrong door” system: No matter how someone comes in, whatever service brought them to us, they get connected to what they need. We help King County residents access not just healthcare, but also resources like food, utility assistance, behavioral health, job training and placement, housing, financial literacy, legal support and more.
At the Chinese Information and Service Center, or CISC, we partner with HealthierHere and the public sector to help immigrant communities find services that improve their health and well-being. Earlier this year, we were notified that up to 124 immigrants and refugees in our care, many of whom escaped war, could lose healthcare. Many are battling cancer, Alzheimer’s disease and other chronic illnesses. These families are facing difficult choices between remaining fully employed to support the household or becoming a caregiver for their loved one. The center is trying to fill gaps by connecting clients to state-funded emergency programs.
In addition to the thousands who will lose care altogether, it is estimated that more than 70,000 people in King County will require case management support to just retain their coverage.
HealthierHere is working with the city of Seattle to seek funding in the budget to expand case management to those who need support to retain Medicaid coverage, because the only way to address this national crisis will be on the local level through partnerships across government, nonprofits, philanthropy and business.
It is important to remember that when the federal government cuts Medicaid, it’s not just cutting health insurance — it’s also cutting the critical support services that help manage care for Washingtonians with little to no incomes. Thousands of our neighbors across the state are relying on these benefits to get the care they need, and our organizations and our partners stand ready to work together with state and local government to fill the gaps.
