House Resolution 1, or HR 1, officially took effect earlier this month on October 1. HR 1, also known as “One Big Beautiful Bill” (OBBB), made changes to Medicaid and Big changes coming to health coverage in Washington. HR 1 is rewriting the rules for Medicaid, also known as Apple Health in Washington state. Nearly 2 million people across the state rely on it, including a majority of our clients. Some changes are already in effect, but the biggest changes are coming up in 2027.
On October 1 of this year, new changes in eligibility took effect for certain non-citizen groups, including “refugees, asylees, and other noncitizen adults.” This included 11,000 refugees, asylum seekers, and other lawfully present immigrants in Washington state, including 4,000 immigrants in King County.1
That’s just the first round. Beginning January 1, 2027, adults ages 19 to 64 who receive Apple Health will be required to meet new work requirements. The requirements involve participating in or enrolling in a work, education, work program, community service project, or volunteering, or a combination of these that total at least 80 hours per month. The 64 age cap is an increase from age 54, which now leaves hundreds of thousands of people scrambling to ensure they are eligible. People who do not meet these requirements could start losing coverage as early as January 31, 2027. More than 600,000 Washington residents will be affected by the new rules. King County Councilmember Teresa Mosqueda recently stated that up to 215,000 of those affected live in King County.2
Eligibility renewals will also change from every 12 months to every six, creating an additional burden on recipients to make sure they can receive the coverage they need for the year. While many will qualify for an exemption, the burden of proof and the process of renewal is the true obstacle, as it will mean keeping track of paperwork, keeping up with mailings and submission deadlines, and navigating online portals twice as often as before. There are exemptions for people who are “medically frail” and unable to work, including those with mental disorders or disability that significantly impacts their ability to meet the requirements, but these are required to be verified by the state.
However, qualifying isn’t the same as staying covered. The people we serve at Transitional Resources live with serious mental illness and often have other co-occurring disorders or disabilities that impact their ability to work. Many of the individuals we serve have experienced severe behavioral health crises as well as periods of chronic homelessness, meaning it can already be a challenge for people to ensure they get the coverage they qualify for with the current yearly renewal. It can take a long time to track down documentation and materials needed to prove eligibility, and the people we serve sometimes have trouble keeping track of these items long-term. Now with a bi-annual renewal, one missed notice can mean losing the medication, treatment, and support that keeps them housed and in recovery.
People’s needs don’t vanish when coverage shifts, but instead appear in other places like the emergency room, on the streets, or as a crisis, and then it takes even more time and effort to help people get the support they need. While coverage can be reduced on paper, TR will continue to show up for the people we serve affected by these new changes, helping them keep appointments, hold onto documents, renew benefits on time, and stay connected to care.
Your gift has a powerful, direct impact on our work right now; when public dollars fall short, it’s the support from our community that keeps our doors open and our programs running. Thank you for standing with those we serve.
You can read more here about the updates that HR-1 will have on Apple Health.