Bellevue residents on Apple Health, Washington's Medicaid program, face two hard deadlines that could interrupt their medical care: Oct. 1, when some non-citizens lose eligibility, and Jan. 1, 2027, when all adults 19–64 must meet new work requirements and re-certify every six months.

An estimated 12,000 non-citizen immigrants statewide will lose Apple Health coverage on Oct. 1 under provisions of H.R. 1, the federal spending law signed by President Trump on July 4, 2025, according to Northwest Asian Weekly.

In King County alone, roughly 40,000 people are expected to need case management help to keep their coverage, according to nonprofit HealthierHere.

Daphne Pie, regional health administrator for Public Health – Seattle & King County's Access & Outreach program, said in a Public Health Insider interview published Aug. 25 that her team is racing to connect people with navigators before the deadlines hit.

She warned that without preparation, people could lose access to medication or treatment, "even if they qualify."

Who loses coverage Oct. 1

Non-citizens age 19 and older who are legally present, including refugees, asylees and individuals with withheld deportation or removal orders, will no longer qualify for Apple Health.

Exceptions exist: those who have obtained a green card, have a qualifying medical condition, are pregnant or were pregnant in the past year, or qualify for another Apple Health program may keep coverage.

King County Public Health sent letters on July 1 urging affected residents to update their citizenship status if eligible.

Work requirements starting Jan. 1, 2027

Beginning Jan. 1, 2027, adults 19–64 must satisfy at least one of these conditions each month to stay enrolled:

  • Earn at least $580 per month
  • Be enrolled in school at least half-time
  • Participate in a work program
  • Complete 80 hours of community service or training
  • A combination of qualifying activities totaling 80 hours per month

Exemptions for caregivers, people with serious medical conditions and others are still being finalized by the Washington State Health Care Authority. During 2027, enrollees can self-verify compliance; official documentation will be required starting in 2028.

Retroactive coverage is also shrinking. For adults 19–64, it drops from three months to two. For children, pregnant women and other Apple Health programs, it drops from three months to one.

A federal judge in Boston declined on July 30 to temporarily block the work-requirement rule but fast-tracked the case. Twenty-five state attorneys general and Washington, D.C., are challenging the regulation. No ruling on the merits has been issued, and the Jan. 1, 2027, deadline remains in effect.

Nationally, the work requirements are projected to reduce Medicaid enrollment by roughly 5 million people and save $385 billion over the next decade, according to Republican proponents of the bill, as Politico reported.

How Bellevue residents can get help

King County's Access & Outreach team, the county's lead navigator organization, is coordinating with hospitals, community groups and state agencies to identify people at risk before the deadlines hit. Hundreds of navigators and advocates are meeting Friday, Aug. 28, at the monthly First Friday Forum for extended training on the changes.

Residents can get free, confidential help through King County's Community Health Access Program (CHAP):