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Do you need extra support?
If you are feeling like you need extra support with managing daily stress, chronic health conditions -including stopping smoking or speaking with a nurse about your medications, struggles with alcohol or drug use and would like to connect with a behavioral health counselor or substance use disorder professional, we are here to help. Click to find support and resources.
Washington Apple Health (Medicaid)
Medicaid
Our plan offers a range of physical and behavioral health benefits. View the benefits below to see all that it offers. It's for people who meet income and eligibility requirements for Apple Health (Medicaid). We serve pregnant individuals, children and young adults to age 21, families and adults.
Clallam, Cowlitz, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston, Wahkiakum, and Whatcom.
Benefits & Features
Asthma and COPD Support
Individual care to help control your child's asthma.
Does your child have trouble managing asthma or COPD symptoms? A nurse who specializes in breathing issues can really help. Your child will get a customized treatment plan and medicine to:
- Manage flare-ups.
- Reduce symptoms.
- Let your child stay active.
Choose a Birth Center
Where you have your baby is an important choice. That's why you can pick from large network of hospitals all across Washington.
We also encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.
Choice of Doctor
You will have a primary care physician (PCP) who will be your main doctor. Your PCP is the person you should see for most of your care. This includes checkups, treatments, vaccinations, minor injuries and health concerns. Talk to your PCP about any behavioral health concerns you may have. Your PCP can help you decide the right options for you.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Use the Doctor Lookup tool to see if your doctor is in our network. If you don’t have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Diabetes Support
If you have diabetes, we'll help make life a little easier for you. You'll get medicine, supplies and education to help you reach and stay your best. You are also rewarded with gift cards for taking simple steps to manage your diabetes.
Our diabetes program also includes self-care training and classes focused on:
- Planning healthy meals.
- Managing stress.
- Living a healthy lifestyle.
Equipment and Medical Supplies
Your health and safety at home are important.
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
- Hospital beds.
- Oxygen tanks.
- Wheelchairs or walkers.
Foot Care
If you have diabetes or a circulatory condition, good foot care can help prevent much more serious problems. We provide the needed exams to help keep your feet in great shape.
Our podiatry coverage includes:
- Routine foot exams.
- Tips about foot care and choosing the right shoes.
- Information about nerve damage warning signs.
Health Education
Free coaching to help improve your health or to address a condition.
Our plan includes coaching on diabetes, nutrition and more. You can even get a ride, if needed, to and from the class at no cost to you.
Healthy First Steps®
Build a healthy future for you and your baby and earn great rewards with Healthy First Steps. Our program will help you take the right steps to keep you and your baby healthy. Plus you can earn $20 just for signing up.
We will help you:
- Choose a pregnancy provider and a pediatrician (child’s doctor).
- Schedule visits and exams and arrange rides to your visits.
- Earn rewards for going to visits throughout your pregnancy and baby’s first 15 months of life.
- Get supplies, including breast pumps for nursing moms.
- Connect with community resources such as Women, Infants and Children (WIC) services.
Hearing Care
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
We cover exams and testing, as well as hearing aids for enrollees.
Home Health Care
After surgery or a serious illness—or if you have a disability—you may need extra help with day-to-day tasks. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:
- An in-home medical visit.
- Medical equipment like hospital beds, walkers or wheelchairs.
- Disposable medical supplies.
- Help with personal care or housekeeping.
Hospitalization
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Our plan covers:
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Interpreters
Your doctor and you need to understand each other. Not speaking English well makes this difficult. We can arrange for a medical interpreter to be at your appointments.
We also have people in member services who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.
Kidney Disease Care
Kidney disease is a serious medical condition. After the kidneys stop working, regular treatments, called renal dialysis or an organ transplant are needed to live. Dialysis uses a machine to clean the blood just like healthy kidneys do.
Our plan includes:
- Dialysis.
- Medications.
- Health education and support.
- Organ transplant if needed.
Lab and X-rays
Knowing what's wrong and finding it early can make all the difference. Our plan covers:
- Labs and testing.
- X-rays, scans and other imaging.
We'll help you get the information needed to improve your health or be at your best.
Language Help
You can receive information in your preferred language. Just ask. We also have people at our customer service centers who speak more than one language. Chances are, we have someone who speaks your language or they can connect you with our interpreter service which covers more than 170 languages.
Member Services
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call. We’ll answer your questions simply and completely.
We can also help you find:
- Home care providers.
- Dentists and vision providers.
- Adult Day Health Centers.
Medicines
Our plan includes prescription drugs and refills with no copays. We also cover over-the-counter medicines with a written order from your doctor.
And we make getting your medicine easy. You can fill your prescriptions at:
- Local pharmacies.
- Services that deliver routinely right to your door.
Mental Health Services for Children and Youth
Problems such as depression and anxiety can also be challenging for children and teens.
There are no costs for covered services. We have therapists and doctors for youth and teens that can address their specific behavioral health or substance use. Help get them extra support to live a heathier life.
Look for behavioral health providers or call 1-877-542-8997, TTY 711
Additional Resources
Teens can connect with teens during specific hours: 866-833-6546, teenlink@crisisclinic.org, www.866teenlink.org
No Cost for Covered Services
Get the quality health care you deserve at no cost for covered services. You get:
- Care from highly skilled and compassionate doctors.
- Treatments at respected hospitals and clinics.
- Home medical equipment and supplies to help you be at your best.
NurseLine℠
Medical questions and situations sometimes happen at inconvenient times. When you have questions about your health, you can call a nurse 24 hours a day, 7 days a week: 1-877-543-3409 (TTY 711).
Our nurses will:
- Listen to symptoms.
- Help with self-care.
- Advise you about getting care at a doctor visit or an urgent care center.
- Help you know when to go to the emergency room.
Nurse Visits
Sometimes continued care is needed after leaving the hospital or urgent care. For example, after a serious illness, surgery or injury. In these cases, a nurse will make home visits to:
- Provide medical care.
- Answer any questions and concerns.
Personal Care
Sometimes the basics are hard to do yourself after an illness or injury.
If needed, we provide someone to help with:
- Dressing.
- Bathing.
- Feeding.
Personal Care Manager
Do you or a family member have a serious health problem? If your health needs qualify then our care managers are in your corner. They will:
- Help manage your physical and mental health care needs.
- Work with your physician, behavioral health specialists and outside agencies.
- Coordinate your doctor appointments.
- Provide your care team with your medical records.
Your care manager will stay with you throughout the medical journey. He or she will:
- Make sure you have support at home.
- Connect you to the social services you may need.
Programs for Kids and Teens
Kids with positive role models make more healthy choices. That's why we provide free memberships to the Boys & Girls Clubs in your area.
Along with fun and games, these clubs offer help with:
- Homework.
- Mentoring.
- Coaching.
Prenatal Visits
Your pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN. With our plan, you will also be rewarded with gift cards for prenatal and postpartum doctor visits.
All recommended prenatal clinical visits and tests are covered by our plan.
At these visits, the clinic will:
- Make sure both you and your baby are healthy.
- Explain what to expect at each stage of your pregnancy.
- Answer your questions.
Residential Care
After a serious illness, surgery or injury you may need extra nursing and therapy. If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:
- Nursing home services.
- 24-hour nursing care.
- Help with activities of daily living.
- Physical, occupational and speech therapy.
Quitting Tobacco
You know the bad health effects of smoking. You know you need to quit. We support you while you quit with coaches and supplies. The only thing you won't get from us is a lecture. Call 1-866-QUIT-4-LIFE (1-866-784-8454) Or visit www.quitnow.net.
Shots and Vaccines
Routine shots help protect you from illness.
So, our plan covers:
- Recommended shots and vaccines.
- Influenza shots.
Therapy Services
Physical, occupational and speech therapy can help you recover from a serious injury or illness, or simply reach your full potential.
Our plan provides:
- Occupational therapy.
- Physical therapy.
- Speech therapy.
- In-home therapy.
Transportation
Get a ride – at no cost to you - to and from health care locations. That includes trips to:
- Doctor or therapy visits.
- Vision clinics.
- Urgent care centers.
Apple Health (Medicaid) pays for transportation services to and from needed non-emergency health care appointments. If you have a current ProviderOne Services Card, you may be eligible for transportation. Call the transportation provider (broker) in your area to learn about services and limitations. Your regional broker will arrange the most appropriate, least costly transportation for you. See the list of brokers
Vision Care
You'll get the care and treatment that let you see life more clearly. Coverage includes:
- Eye exams every twenty-four months for adults and once every twelve months for children and age 21. Eyeglasses, contact lenses, and hardware fittings are covered separately under Apple Health (Medicaid) coverage without a managed care plan (also known as fee-for-service).
- Annual eye exams for members to age 21.
Well Visits
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated. Preventive services include:
- Checkups children.
- Screenings for adults.
- Well-baby care.
- Care for women expecting a baby.
- Routine shots and tests.
- Mammograms.
There are no copayments for preventive care.
Wellhop for Mom & Baby
Connect with other expectant moms. Get support and information during your pregnancy and after you deliver. This program is part of your health plan and there is no extra cost to you.
Here’s how it works:
- Join video conversations every other week with women who have similar due dates and a group leader.
- Chat and share experiences with moms from your group on the Wellhop app or website.
- Visit the Wellhop library. You’ll find articles, videos and more.
Member Resources
Member Resources
Apple Health (Medicaid)
Important Information and Disclosures
Information about Renewing Your Coverage
Renewing Your Coverage
Apple Health (Medicaid)
Have you received information asking you to take action so that you can keep getting benefits?
You can renew your coverage by contacting Washington Healthplanfinder.
Online: wahealthplanfinder.org
Or call: 1-855-923-4633, TTY/TDD 1-855-627-9604
We're here to help you.
Call us toll-free at 1-866-686-9323, TTY 711.
Don't let your health care coverage end. It's too important.
Member Handbook
Member Handbook
Member Newsletters
2021
Winter
2020
Fall
Summer
Spring
Winter
2019
Fall
Summer
Spring
Winter
Advance Directives
Advanced Directive
An advance directive puts your choices for health care into writing.
How To Contact Us
Contact Us
If you have questions about your health plan, please call us. Our toll-free Member Services number is 1-877-542-8997 (TTY: 711).
There will be people who can speak to you 24 hours a day, 7 days a week in English, Spanish and Vietnamese when you call.
Clinical Practice Guidelines
Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for conditions including:
- Asthma
- Attention deficit hyperactivity disorder (ADHD)
- Bipolar disorder
- Chronic obstructive pulmonary disease (COPD)
- Depression
- Diabetes
- Heart disease
- Heart failure
- High blood pressure
- Obesity
- Prenatal care
- Pediatric preventive healthcare
- Substance abuse disorders
- Transplants
View the entire list of guidelines or call our Member Services at 1-877-542-8997 (TTY: 711) to request a printed copy.
For Prior Authorization Guidelines, click here. For Policies and Clinical Guidelines, click here.
Provider Advisory Committee Approval - July 24, 2019
Notice of Privacy Practices
Notice of Privacy Practices
We have a Notice of Privacy Practices that tells you how health information about you may be used and shared. We are required by law to let you know that the Notice is available, and how you can get a copy of it.
View a copy of our Notice of Privacy Practices.
Your Rights and Responsibilities
You have certain rights and responsibilities when you enroll. It is important that you fully understand both your rights and your responsibilities. For detailed information about your rights and responsibilities download here.
Filing a Grievance
If you are not happy with the service UnitedHealthcare Community Plan has provided, you can file a grievance. Download our Grievance and Appeals Process Form below.
Grievance and Appeals Form
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Grievance and Appeals Form - English & Espanol (Opens in a new tab)
(pdf 106.42KB)
(Last Updated:
11/12/2020)
Conversion Rights
Members have the right to obtain a conversion agreement to continue health and medical benefits upon termination of Apple Health (Medicaid) eligibility.
If you have questions or to obtain a conversion agreement, please call us. Our toll-free Member Services number is 1-877-542-8997 (TTY: 711).
Medical Prior Authorizations
We require prior authorization on all out-of-network referrals. The request is generally processed like any other authorization request. The nurse reviews the request for medical necessity and/or service. If the case does not meet criteria, the nurse routes the case to the Medical Director for review and determination. Out-of-network referrals are generally approved for, but not limited, to the following circumstances:
- Continuity of care issues
- Necessary services are not available within network.
Out-of-network referrals are monitored on an individual basis. Trends related to individual physicians or geographical locations are reported to Network Management for review.
To find out if a prior authorization request has been approved, check with your provider or call member services, at 1-877-542-8997 (TTY: 711). If the prior authorization request is denied, you will be notified in writing, including your right to appeal this decision.
Translation Resources
UnitedHealthcare Community Plan provides member materials to you in a language or format that makes it easier for you to understand. Our provider network includes many doctors who are multilingual. Our provider directory shows which languages doctors speak. Additionally, many of our Member Services representatives speak multiple languages, so when you call they will be able to help you or connect you with our interpreter service which covers more than 170 languages.
If you have trouble hearing over the phone you can use a text telephone. This free service allows persons with hearing or speech disabilities to place and receive telephone calls. Call 711, give them the Member Services number 1-877-542-8997, and they will connect you to us.
You can also get information in large print, Braille or audio tapes. We can also assist with interpreter services, including American Sign Language. To ask for help, please call 1-877-542-8997, TTY 711, Monday through Friday, 8:00 a.m. to 5:00 p.m.
Our toll-free Member Services number is 1-877-542-8997 (TTY: 711).
Forms and Notifications
Pharmacy Direct Member Reimbursement Form
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Pharmacy Direct Member Reimbursement Form - English (Opens in a new tab)
(pdf 96.51KB)
(Last Updated:
11/13/2020)
The Medically Intensive Children's Program
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The Medically Intensive Children's Program - English (Opens in a new tab)
(pdf 384.72KB)
(Last Updated:
11/12/2020)
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The Medically Intensive Children's Program - Español (Opens in a new tab)
(pdf 393.24KB)
(Last Updated:
11/12/2020)
Authorized Representative
Download the Appointment of Authorized Representative Form. This form lets a UnitedHealthcare Community Plan member choose someone to help or act on their behalf.
Collaborative Care Model
Many patients suffer from behavioral health problems such as depression, anxiety, and substance use disorder. This model enhances services provided by primary care providers by collaborating with behavioral health providers. And helps patients live a healthier life.
Services include:
- Care management support for patients receiving behavioral health treatment
- Regular psychiatric inter-specialty consultation
- Shared targeted treatment plans that incorporate patient goals.
You can find a list of participating providers below in English, Español or call 1-877-542-8997, TTY 711. For more information visit https://aims.uw.edu
List of Collaborative Care Participating Providers
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List of Collaborative Care Participating Providers - English (Opens in a new tab)
(pdf 45.37KB)
(Last Updated:
11/12/2020)
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List of Collaborative Care Participating Providers - Español (Opens in a new tab)
(pdf 45.67KB)
(Last Updated:
11/12/2020)
Learn More
Apple Health (Medicaid)
How you qualify.
Get the health care you deserve.
Washington Apple Health (Medicaid) coverage provides comprehensive medical benefits to adults, families, individuals with disabilities, children under 19, and pregnant indivduals who meet income and eligibility requirements.
Anyone between ages 19 to 65, who meets income and eligibility requirements, may be eligible for Apple Health (Medicaid) coverage. There are no pre-existing condition restrictions.
To see if you qualify, go to wahealthplanfinder.org or call 1-855-WAFINDER (1-855-923-4633) TTY/TTD 1-855-627-9604.
For more information on Apple Health (Medicaid), please visit the Health Care Authority website.
Looking for a change?
If you are currently enrolled in Apple Health (Medicaid) and would like to change to UnitedHealthcare Community Plan we can help.
There are several ways to switch your plan:
- Change your plan on the Washington Healthplanfinder website.
- Visit the ProviderOne Client Portal website.
- Request a change online:
- Select the topic “Enroll/Change Health Plans.”
- Call the Health Care Authority at 1-800-562-3022 (TTY: 711).
- Other members should call Apple Health Customer Service at 1-800-562-3022 to cancel/terminate Medicaid coverage. Hearing or speech impaired members should call TTY: 711.
Get the details.
To find out if you qualify visit wahealthplanfinder.org or call 1-855-WAFINDER (1-855-923-4633) TTY/TTD 1-855-627-9604.
We can also assist with interpreter services, including American Sign Language. To ask for help, please call 1-877-542-8997, TTY 711, Monday through Friday, 8:00 a.m. to 5:00 p.m.
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