Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Washington program

Apple Health after a long hospital stay

A route for families over the ordinary income line, when a stay is expected to last 30 days or more.

What it is

A route for families over the ordinary income line, when a stay is expected to last 30 days or more.

A stay of 30 or more consecutive days lets the state count only the child’s own income, for a family over the ordinary line. Ask the hospital’s Medicaid specialist before day 30; an expected stay can count. It does not depend on how long ago leukemia was diagnosed.

Rules
  • The stay must meet the institutional rules; a leukemia diagnosis alone does not qualify. Direct transfers count; disconnected short stays do not add up.
  • After discharge, coverage continues through the remainder of the existing 12-month certification, not a new year.
  • Roads to Community Living has further requirements; a long stay alone is not enough.
What you get
  • Coverage during an expensive admission for a family otherwise over the line.
Detail
  • K01 uses a one-person income calculation and has no resource test.
If you decide to apply
  1. If the team thinks a stay of 30 days or more is likely, ask the hospital's Medicaid specialist to review the expected admission and this route before day 30.

Hospital Medicaid specialist

If it becomes relevant
  • Give the specialist the admission date, expected discharge and the child’s own income.
Good to know

Treatment phase alone does not establish the length of a stay.

Other details
  • This is not a Washington at-home Katie Beckett waiver.

Federal background: Other ways to qualify for Apple Health.

Official sources
Ask your social worker

“Is there any reason the long-stay Apple Health route would matter for us?”

Why I’m asking: We want to know what to ask if a long admission happens.

More background and detailed requirements

How this could help

Families who earn too much for ordinary Apple Health should ask the hospital’s Medicaid specialist about Children’s Institutional Medical. The specialist reviews the admission and the child’s own income under different rules. An expected qualifying stay can be considered before day 30; there is no need to wait until the last day to ask.

This can provide health coverage during an expensive admission. Ask the specialist to explain the approval dates and continued coverage after discharge in writing, and to coordinate it with any private insurance.

What to know before you apply

  • The hospital stay must meet the institutional rules; a leukemia diagnosis alone does not qualify.
  • Tell the specialist about income paid to or for the child, and any transfers between facilities.
  • Children approved for the applicable categorically needy coverage generally have continuous coverage; confirm the individual certification period.
  • K01 uses a one-person income calculation and has no resource test. After discharge, qualifying coverage lasts through the remainder of the existing certification, not a fresh year.

Your next steps

  1. Ask the hospital’s financial counselor whether the current or expected stay meets the 30-day institutional rule.
  2. Give them the admission date, expected discharge information and the child’s income details.
  3. Before discharge, ask who will manage the coverage and whether a separate transition program applies.

Roads to Community Living has separate qualifying-stay, Medicaid and discharge requirements; a 60-day stay alone does not promise an additional year of coverage.

This is an institutional eligibility route, not a claim that Washington has a general at-home Katie Beckett income waiver.

Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Provide admission and transfer dates and details of money received by or for your child; do not assume the child's income is zero.

Your social worker

The hospital eligibility team supplies admission evidence and coordinates the correct K01 application with HCA.

The care team

The team says in the record how long the admission is expected to last, which is what makes an expected stay count.

Who decides
The Health Care Authority, on the hospital's record of the stay.
Ask your social worker
“Could this admission qualify my child for Apple Health using their income rather than ours?”

How to apply

First step: Ask the hospital’s financial counselor whether the current or expected stay meets the 30-day institutional rule.

  1. Ask whether this admission is expected to last at least 30 consecutive days, including direct medical-facility transfers.
  2. Have the hospital eligibility team use its current HCA K01 process and confirm the child's income, category and coverage dates.
  3. Before discharge, confirm the certification end date. Ask about RCL only if the separate stay, Medicaid and community-service requirements may fit.

Official application / program page ↗

Where it starts: Ask the hospital's eligibility team for its current HCA K01/MAGI institutional process tied to the Healthplanfinder application and expected-stay evidence. Do not substitute a generic disability/long-term-care form or send records to an unverified email address.

What to gather

  • Admission, direct-transfer and expected discharge dates
  • Money received by or for your child, with source and recipient
  • Current Healthplanfinder application or coverage information

How long: Ask HCA and the hospital team to confirm the current processing route and effective date; no specific K01 processing deadline is asserted here.

What a yes looks like

An approval naming the coverage start and certification end dates, including the remainder that continues after discharge.

What a no looks like, and the next move

Ask which requirement was not met and which other Apple Health category HCA considered; follow the appeal instructions on the notice.

Watch out

  • Ask the hospital's Medicaid specialist before day 30 if the stay is expected to qualify. Direct transfers can count together; separate short admissions are not simply added. After discharge, coverage can continue for the remainder of the existing 12-month certification, not a new year starting at discharge.
  • The MAGI institutional category has no savings test. A child already receiving SSI needs a different category review.
  • DDCS waivers and HWD have separate eligibility rules; the long-stay route is not the only possible alternative.

Dates that change this

2026-09-15: Current rules verify expected/consecutive stays and continuation through the existing certification. Operational admission/discharge-day counting and exact effective dates still require HCA confirmation.

The numbers and the rules

The arcane layer, kept on purpose. Checked September 15, 2026.

What it is worth

A qualifying actual or expected 30-day stay can permit a one-person Apple Health income calculation for your child.

  • $30 — Consecutive institutional days, actual or expected, that trigger the rule
  • $12 — Existing certification period; discharge preserves its remainder, not a new period
  • $60 — Qualifying stay for Roads to Community Living
  • $365 — Separate Roads to Community Living period after an approved transition

Covers: Apple Health medical coverage using the institutional child's income calculation · Separate Roads to Community Living assessment when its additional requirements are met

Legal protection: Coverage can continue after discharge through the remainder of the approved certification, subject to age-out, move and death exceptions

What it costs the family: No contribution toward care is required under the MAGI institutional category; covered-service and provider rules still apply.

The eligibility facts, as published

Age
under 19
Age max exclusive
19
Income
One-person medical-assistance unit; only income received by or on behalf of the child is evaluated under MAGI. The effective no-cost standard is 215% FPL for one person, not the family's three-person limit.
Level of care
At least 30 consecutive days in a qualifying medical institution, actual or expected under an HCA/department assessment. Direct medical-facility transfers preserve status; exact admission/discharge-day counting requires the current HCA procedure.
Residency
Washington
Continuous eligibility
The remainder of the existing 12-month certification continues after discharge unless the child ages out, moves out of state or dies.
Roads to community living
Separate program: at least 60 consecutive qualifying days excluding Medicare-only days, a Medicaid-paid inpatient day immediately before discharge, eligibility at discharge, functional assessment and an approved transition. The 365-day period and its exceptions apply only after approved RCL discharge.
Resources
No resource test for the MAGI institutional route (WAC 182-514-0245). SSI-related institutional routes have different rules.
Other category condition
A child receiving SSI is not eligible for this MAGI LTC category; the agency checks the appropriate SSI-related route.

Decisions this site cannot make: Institutional status finding · Health Care Authority institutional eligibility decision

Expect friction on: Getting the expected length of stay written into the record early

The trap: Ask the hospital's Medicaid specialist before day 30 if the stay is expected to qualify. Direct transfers can count together; separate short admissions are not simply added. After discharge, coverage can continue for the remainder of the existing 12-month certification, not a new year starting at discharge.

Where I read this

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