Washington requests amendment to Section 1115 MTP waiver to expand coverage for former foster care youth


Shane Ersland


The Washington State Health Care Authority (HCA) and Department of Social and Health Services (DSHS) recently requested an amendment to Washington’s Section 1115 Medicaid Transformation Project (MTP) waiver that would expand coverage for former foster care youth.

The Centers for Medicare & Medicaid Services (CMS) recently approved Washington’s request to extend and amend its Section 1115 MTP waiver, which will allow Washington to implement new policies and use federal Medicaid funds to improve Apple Health, the state’s Medicaid program. The waiver ended on June 30th, and the extension runs through June 30th, 2028.


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The state’s new amendment request would provide Medicaid coverage for former foster care youth—also known as Alumni coverage in Washington—from other states who turn 18 prior to Jan. 1st. Coverage would remain intact until enrollees reach age 26. Coverage would apply through Dec. 31st, 2030. The state estimates that 180 former foster care youth enrollees will be eligible for coverage during the current MTP waiver period (through June 30th, 2028).

The amendment would also provide continuous enrollment for Children’s Health Insurance Program (CHIP) coverage for CHIP (an Apple Health program) children during the first six years of their lives. CMS approved continuous Apple Health enrollment for children through age five under the MTP waiver’s renewal agreement.

If approved, the amendment would allow CHIP children to be continuously enrolled until the end of the month in which their sixth birthday falls. The state is requesting an expansion of federal authority under the MTP waiver to provide continuous enrollment to children, through age five, who are enrolled in CHIP with incomes up to 317 percent of the federal poverty level. Washington estimates that 16,707 enrollees will be continuously enrolled from 2024 to 2028.

“If approved, this amendment will allow Washington to continue providing coverage and ensuring access to health services for children and individuals who are at risk of discontinuity in care. Continuous and comprehensive access to coverage is especially important for children and individuals experiencing health and behavioral issues. Inconsistent coverage or disruption of coverage could lead to unmet healthcare needs and delays in diagnoses, preventive services, and treatment.”

MTP waiver amendment request

Gaps in coverage are higher for children of color, ages zero to six, according to the amendment request. The state’s data shows that there is 46 to 63 months of disruption in coverage over a five-year period for every 100 children within this group.