Bookmark & ShareBasic Health partners with many organizations around the state to help applicants and members. This page is dedicated to those community partners. The information below should help you as you assist the applicant or member. If you can't find what you are looking for, please call 1-800-660-9840.
Basic Health has a Wait List
To stay within the appropriated budget, Basic Health is no longer processing incoming applications to determine eligibility and has officially implemented a waiting list. New applicants will be placed on a list behind those already waiting. When space becomes available in the future, Basic Health will release names from the list in date-received order and notify applicants.
The following groups, however, may by-pass this wait list. This includes:
- Foster Parents
- Personal Care Workers
- Health Coverage Tax Credit (HCTC)
- Tribal Sponsored Accounts
- Washington National Guard or Reserves who served in Operation Enduring Freedom, Operation Iraqi Freedom, or Operation Noble Eagle.
- BH Plus and Maternity applicants who we sent to DSHS and who were deemed ineligible for DSHS programs.
- Former BH members who disenrolled due to Medicaid coverage who have since lost that coverage and notified BH within 30 days.
To request an application for these programs please call 1-800-660-9840.
If you would like to get your name on the wait list, please call 1-800-660-9840 or register online. We will notify you when space becomes available.
Frequently asked questions (FAQs) about the wait list.
The Department of Social and Health Services (DSHS) may be able to help you with medical assistance.
Income Guidelines (effective 7/1/12 - 6/30/13)
Additional Forms and Information
Income
Family Income Reporting form (225.3 KB)
Zero income statement- Alternative Income Statement: English (21.5 KB) | Spanish (71.8 KB)
Income average summary (33 KB)- Income documentation process and table (102 KB)
Plan Information
- 2013 Coverage Area Map (111.2 KB)
- 2013 Plans and Premiums (74.7 KB)
Miscellaneous
- Frequently asked questions about dually eligible members (28.6 KB)
- Top processing delays
- Order bulk materials (not for individual use)
Request for copy or transcript of tax (IRS Form 4506-T)- Reassignment of Funds: English (118.5 KB) | Spanish (118.5 KB)
- Recertification
- Acceptable IRS forms or other documentation (11.8 KB)
- Permission form: English (122.4 KB) | Spanish (167.3 KB)
- Declaration of Non-filing Status: English (65.2 KB) | Spanish (34.6 KB) | Both
- Out-of-Country Spouse: English (21 KB) | Spanish (21.7 KB)
- Medicare form (28 KB)
- Spanish Medicare form (40.5 KB)
- Stakeholder Questions and Criteria (88 KB)
- Basic Health Timeline (33.3 KB)
- 2011 Disenrollment Timeline (40.1 KB)
- Examples of Proof of Legal Residency
Sample Letters
- OE Notice - Choice: English (211.4 KB) | Spanish (224.9 KB)
- OE Notice - Without Choice: English (138.4 KB) | Spanish (149.6 KB)
- Notification of Receipt Postcard (84.9 KB)
- Eligible for DSHS (28.9 KB)
- New Applicants - Held/Delayed (73.2 KB)
- New Applicants - Not Enrolling (31.3 KB)
- Held/Delayed Applicants - Not Enrolling (30.1 KB)
- Unverified Applicants - Not Enrolling (30.1 KB)
- Medicaid Disenrollment (32.9 KB)
- SSN Verification - Valid February 2011 Only: English (52.8 KB) | Spanish (41.4 KB)
- Notice of Disenrollment: English (91.9 KB) | Spanish (91.2 KB)
- Non-Transitional Eligible Over 65 Disenrollment: English (91.6 KB) | Spanish (88.9 KB)
- Non-Transitional Eligible Over 133% FIG: English (91.4 KB) | Spanish (88.9 KB)
- Apple Health for Kids Transition: English (56.1 KB) | Spanish (57.7 KB)
- Correction Notice - Disenrollment Appeal (sent to Spanish population only): English (81.2 KB) | Spanish (81.7 KB)
