Washington offered state Medicaid to undocumented adults. Thousands still don't have coverage

Washington state has extended new health insurance options to undocumented immigrants, but thousands of people who are eligible are still waiting for coverage.

In June, Washington began offering Apple Health — or state Medicaid — to undocumented adults with incomes below 138% of the poverty line. That’s $20,874 for one person or $28,212 for a two-person household.

But there was a budget cap — $76.8 million — so only the first 12,000 or so eligible applicants got insurance. Within two days, the program was full for most age groups.

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Now, nearly 8,000 people are in a waiting pool — eligible for the program but so far unable to get in due to the limited funding.

“If that says anything about the need for this program, it’s obviously quite high,” said Sasha Wasserstrom, the policy director at the Washington Immigrant Solidarity Network.

As a doctor at SeaMar Community Health Center in White Center, Julián Pérez often sees undocumented, low-income patients. He said many of them applied for Apple Health after it was opened to them. One of those patients is a hotel housekeeper who needed knee surgery.

“This is a patient who says, ‘I can barely walk. I have to work. Who’s going to feed my kids?’” Pérez said. “She didn’t have insurance, so [her best option was to] get in line and wait for charity care. It’s going to be many, many months.”

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But then, she got Apple Health and was able to schedule her knee surgery within a month.

Pérez said he had far more patients who did not get in. And when people don’t have health insurance, he said, they avoid going to the doctor.

“Typically, they would come to us very advanced in their disease,” he said. “When they finally come in — with renal failure or fevers and seizures — that’s usually when we would see them.”

Wasserstrom with the Washington Immigrant Solidarity Network said the state so far has done “very minimal outreach, so if we were to really go all in on outreach, we’d find that there are so many more folks who would be eligible for this program.”

They said they’re asking state lawmakers to remove the budget cap entirely and offer Apple Health insurance to all income-eligible Washington residents.

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Another new option for undocumented adults in Washington — available since November 2023 — is to buy health insurance on the state’s exchange. And they can qualify for state, but not federal, subsidies.

But the available plans, “even with state subsidies, [are] very inaccessible to folks,” Wasserstrom said. “We’re hearing from community members, ‘What’s the point of being able to access this if we can’t afford it?’ … This is a $700 a month cost for folks —at least that’s what it is for some folks — and that’s just too high.”