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Changes to Medicaid and Qualified Health Plan enrollment due to the U.S. Congressional H.R.1 Bill

On July 4, 2025 the H.R.1 bill was passed by the U.S. Congress which made significant changes to Medicaid (Apple Health) and Qualified Health Plan enrollment. Here are the changes that may affect your eligibility for health insurance.

Short URL: kingcounty.gov/coverage/HR1

Apple Health Medicaid

October 1, 2026

  • Non-citizen adults, 19 years and older who currently qualify will no longer be eligible.  Refugees, asylees and other non-citizens will no longer be eligible for Apple Health/Medicaid.

January 1, 2027

  • Work requirements for adults age 19-64 (work, training, or community engagement, for 80 hours per month, with exemptions. If you need assistance documenting your exemption, contact the Community Health Access Team (CHAP) at 800-756-5437.
  • More frequent eligibility checks.  Adults 19-64 will be required to renew eligibility every 6 months
  • Retroactive coverage periods reduced
    • Adults 19-64 reduced from 3 months to 1 month
    • Children, pregnant women and other Apple Health programs reduced from 3 months to 1 month

October 1, 2028

  • Cost-sharing. Individuals on Medicaid may be charged up to a $35 co-pay for many services.  If a client is obtaining services from a Public Health Center or Community Health Center (i.e. HealthPoint, NeighborCare, Seattle Roots, ICHS), there are no co-pays.

October 1, 2029

  • Address verification. The Washington State Health Care Authority is working on how to verify and what documentation will be required to verify an address.

Qualified Health Plans (QHP)

October 1, 2025

  • Loss of Tax Credit eligibility for DACA Recipients. DACA recipients are no longer considered lawfully present and are ineligible to receive Tax Credits to purchase a Qualified Health Plan

January 1, 2026

  • Loss of Tax Credit eligibility for low-income lawfully present immigrants. Lawfully present immigrants with incomes below 100% FPL are no longer eligible to receive federal subsidies to purchase health insurance
  • Removing Advance Premium Tax Credit repayment caps for those under 400% FPL
  • Loss of Enhanced Premium Tax Credits. Enhance premium tax credits expired as of Jan 1, 2026.

November 1, 2026

  • Shortening the open enrollment period. Open enrollment will take place from November 1, 2026 to December 31, 2026.

January 1, 2027

  • Loss of Tax Credit eligibility for low-income lawfully present immigrants. Eliminating federal subsidies for many lawfully present immigrants regardless of income or tax filing status
  • No Tax Credit eligibility when denied Medicaid for not meeting work requirement. People who are denied Medicaid eligibility due to work requirements not being met will also be denied QHP federal subsidies

January 1, 2028 and beyond

  • No auto-renewal of Qualified Health Plans. Eliminating automatic re-enrollment and cross mapping into Qualified Health Plans for the next benefit year. During Open Enrollment, you will need to go into the system, update you application and select new coverage for the next year.
  • No conditional eligibility for Qualified Health Plans with tax credits. If there are verifications required to verify eligibility, ie income, identification, ect. The documents must be submitted and verified before you will be eligible to receive Tax Credits when you enroll in a Qualified Health Plan.
  • No tax credits when you fail to reconcile. Canceling Advanced Premium Tax Credit for failure to reconcile after one year. You must reconcile your tax credits when you file your taxes each year.

Training

Navigators and agencies interested in trainings about HR 1 changes, please visit our First Friday Forum site kingcounty.gov/FFF for more information.