About 14,000 lawful immigrants in Washington are set to lose Apple Health coverage Oct. 1. Gov. Bob Ferguson signed an executive order Thursday, Sept. 3, launching a state response to federal Medicaid cuts that could strip coverage from more than 200,000 residents by the end of 2027.
The order creates an H.R. 1 response committee and directs agencies to track coverage losses under the federal budget law President Donald Trump signed on July 4, 2025. H.R. 1 cuts more than $1.3 trillion in healthcare and food assistance nationwide.
Nearly 2 million lower-income Washington residents are enrolled in Apple Health, the state's Medicaid program funded by both state and federal dollars.
Who loses coverage first
The 14,000 lawful immigrants facing Oct. 1 termination include refugees, asylees and people who fled the war in Ukraine. The state has helped about 3,000 of them update their information to keep coverage, the Seattle Times reported.
Starting Jan. 1, 2027, more than 600,000 residents face new work requirements. Adults under 65 without dependent children younger than 13 must prove they work, volunteer or attend school at least 80 hours a month. Enrollees will also have to reapply every six months instead of annually.
"The federal government's changes are all designed for one purpose," Ferguson said at a Sept. 3 news conference in Seattle. "It is thinly veiled: to kick people off Medicaid."
The cost to hospitals
Eric Moll, CEO of Mason Health, a rural hospital in Mason County, said Washington hospitals are projected to absorb roughly $1.5 billion in additional uncompensated care over the next five years, according to Fox 13.
Kelli Nomura, CEO of International Community Health Services in Seattle, said nearly 55% of her clinic's patients rely on Apple Health. If those patients lose coverage, the clinic will no longer be reimbursed for their care. When people lose insurance, they are more likely to delay treatment and end up in emergency rooms, Nomura and other health leaders said at the news conference.
Long-term care enrollees also face cuts. About 1,500 noncitizens receiving long-term care services will lose Medicaid on Oct. 1. Termination notices went out in late August. State lawmakers approved nearly $20 million to retain coverage for some of them, but the funding will cover only 173 people, the Tacoma Daily Index reported.
DSHS Secretary Angela Ramirez said the state identified 1,500 additional people who can keep long-term care services because their immigration status had changed. She warned in August that the cuts would be harmful.
What the state is doing
Ferguson's response committee includes the Office of the Insurance Commissioner and the Washington Health Benefit Exchange. The committee will develop strategies to help residents keep coverage and reduce costs.
The order directs the Department of Health to build an online eligibility verification hub. Ferguson said the automated tool could help about 400,000 residents maintain insurance. The order also directs the state to document and track how many residents lose coverage, KUOW reported. A multilingual public awareness campaign will reach residents through health networks, community organizations, food banks and schools.
State Insurance Commissioner Patty Kuderer said about 40,000 fewer people enrolled in individual health plans through the state exchange for 2026, a 13% decline after Congress let health subsidies expire. Her office will announce final 2027 insurance rates the week of Monday, Sept. 7. In May, insurers requested a 22.4% average rate increase.
Residents enrolled in Apple Health can check their eligibility status through the state Health Care Authority and should watch for letters from the state to avoid losing coverage.
