Clarifying information

When Apple Health coverage is terminated, an individual can request an administrative appeal. This appeal must be requested by the end of the month their coverage is to be terminated in order to be considered timely and to receive continued coverage.

When an individual requests an administrative hearing, the agency sends a notice that includes the approval or denial of continued coverage, the reason for denial of continued coverage (if applicable), and that the individual might be liable for up to two months of medical expenses (overpayments) if continued coverage is received and the agency’s termination is upheld.

An individual is eligible for continued coverage if: An appeal is received by the agency, its designee (including the Health Benefits Exchange), or the Office of Administrative Hearings by 5pm on the last day of the month; or If the last day of the month falls on a weekend or holiday, the appeal is received by 5pm on the following business day; or An administrative law judge issues an order granting continued coverage.

Continued coverage ends the last day of the month when: The individual fails to appear for his or her hearing. An administrative law judge issues an order upholding the agency’s decision; The individual withdraws their appeal. The individual declines continued coverage in writing; or An administrative law judge issues an order stopping continued coverage.

If an individual fails to appear for the hearing or if an order is issued upholding the agency’s decision, the agency may seek reimbursement for the cost of the two months of continued coverage received. See WAC 182-520-0010 for more information.

Continued coverage is not an option when a termination is caused by a change in rule. There is also not an option for continued coverage for medically needy coverage after the original certification period.