Up to 200,000 Washington residents could lose their Medicaid coverage by the end of 2027 under the federal law known as H.R. 1. Gov. Bob Ferguson signed an executive order Thursday, Sept. 3, creating a state response committee and public-awareness campaign to blunt the damage.

The first deadline hits Thursday, Oct. 1, when roughly 11,000 asylees, refugees and survivors of human trafficking will lose federally funded Apple Health eligibility. Starting Jan. 1, 2027, more than 600,000 Washingtonians will face new work requirements and must reapply for coverage every six months instead of annually. The state Health Care Authority's website lists the work threshold at 80 hours per month.

Those 600,000 residents earn up to 138% of the federal poverty level, about $22,000 a year. More than 400,000 of them are under 44.

"I asked my team to find ways to blunt the impact of H.R. 1 on Washingtonians, and they delivered," Ferguson said at a press conference at an International Community Health Services clinic in Seattle. "Their work has preserved health care coverage for hundreds of thousands of Washingtonians."

What the state has done so far

Washington has already spent nearly $100 million implementing H.R. 1, which President Donald Trump signed on July 4, 2025. Replacing everything the federal law cuts would cost the state an estimated $3.2 billion per biennium, according to the governor's office.

State outreach to immigrant communities helped 3,000 lawful immigrants keep their coverage. That reduced the number facing an Oct. 1 cutoff from 14,000 to 11,000.

The state is also building an automated verification hub to confirm eligibility using data the state already holds. Ferguson said Washington is "leading the nation" in developing the system, which is expected to help 400,000 people avoid losing Apple Health when the six-month renewal requirement takes effect.

New committee, new deadlines

Executive Order 26-03 establishes the H.R. 1 Continuous Medicaid Response Committee, led by the Health Care Authority (HCA), the Department of Health, the Department of Social and Health Services (DSHS) and the Department of Children, Youth, and Families. The committee must meet at least every other week for one year.

Within 30 days, the committee must recommend whether to create a longer-term Healthcare Access and Affordability Council. An interim report is due to the governor within six months.

The order also directs agencies to launch a multilingual public-awareness campaign and build a centralized online portal for residents navigating coverage changes. A further change takes effect Oct. 1, 2028: cost-sharing of up to $35 for many Apple Health services.

Beyond Apple Health

The damage extends past Medicaid. Enrollment through the Washington Health Benefit Exchange dropped 13% after Congress let enhanced federal premium tax credits expire. That amounts to 40,000 fewer people with coverage, the largest enrollment drop since the Exchange opened in 2013, Fox 13 reported.

Mason Health CEO Eric Moll said at the Sept. 3 press conference that Washington hospitals are projected to absorb roughly $1.5 billion in additional uncompensated care over the next five years.

Insurance Commissioner Patty Kuderer, who joined Ferguson at the event, told The Olympian her office is reviewing insurance rate increases tied to the federal changes but is required by law to approve those that insurers can justify. The Department of Health must deliver a health-impact assessment framework to the committee within 90 days.

Residents enrolled in Apple Health should verify their information is current and watch for communications from the program.