Have a Heart for Kids Day 2020

Fact Sheet: Federal Bonus for Apple Health For Kids

Apple Health for Kids— Washington state’s children’s health insurance program — has won a $17.6 million performance bonus from the federal government for its outstanding efforts to enroll children in health insurance and help them retain coverage. Washington, a long-time leader in health coverage for children, is one of just 15 states to be awarded a bonus. The award is a boost to the Apple Health for Kids program that many families are relying on to help them through the economic crisis.

The federal Children’s Health Insurance Program Reauthorization (CHIPRA) law—the second bill signed into law by President Barack Obama—created performance bonuses to help states meet the cost of enrolling low-income children. The bonus structure set aggressive targets for enrollment and set a high bar for policies to promote enrollment, efficiency, and retention.

Frequently asked questions and responses from public officials and health advocates here. 

How did Washington qualify?

Starting in December 2009, bonuses will be awarded annually to states that adopt strategies to improve enrollment and retention, and who meet cumulative targets for enrollment. Washington must continue to demonstrate excellence in enrolling and retaining children in order to receive bonus payments each year.

To qualify, states must have implemented at least five out of eight measures for simplifying enrollment and retention. Washington qualified this year because its policies include 12-month continuous coverage, no asset test, no in-person interviews, use of a joint application for both Medicaid and CHIP, and for offering a premium assistance option.

In addition to meeting these criteria, states must enroll an increasing number of children each year. Enrollment targets for this year were based on 3.5% growth in enrollment after accounting for population growth and changes in enrollment driven by the economy.

How can the funds be used?

The Obama administration and Congress clearly intended for the bonus funds to be used by states to offset the costs of increased enrollment in children’s health programs.

Earlier this year, Governor Chris Gregoire reluctantly proposed a cut to Apple Health for Kids, which would leave 27,000 children without health insurance coverage starting March 1, 2011. This performance bonus will cover the cost of preserving Apple Health for Kids, and should be invested in maintaining coverage for all children.

The money should also be used to support efforts that enhance efficiencies in administration and effective use of coverage. These goals can be met through funding community navigators and the Apple Health for Kids hotline, which help families connect to coverage and care, as well as “Express Lane Eligibility,” which cuts barriers to coverage. With these programs, Washington will continue to receive increasing performance bonuses through 2013.

For more information, please contact Jen Estroff, Government Relations Director
(509) 859.2012 or

Reactions to the children's health federal performance bonus

“This award is recognition that Washington state is at the forefront of states that have made children's health coverage a priority. These resources come at a critical time given our economic crisis, and provide a sensible means to continue our effort to ensure that all of Washington's children have health insurance, and that no child should ever have to go without health care.”

-Governor Chris Gregoire


“Apple Health for Kids is a proven win-win for our state and our children. Healthy kids do better in school, help businesses by cutting sick days for parents, and save the state money. I am very proud of Washington’s leadership and success in covering all kids.”

-House Speaker Frank Chopp

“When the Legislature set the goal in 2005 of covering all kids with health care by 2010, we made a real commitment to our young people, their health and their futures. The Apple Health for Kids program has followed through on that commitment, and its success has made Washington a recognized leader in providing children’s health care. These bonus funds help us keep this successful program going in a tough budget environment, and provide an example of how to leverage all available resources to keep our critical commitments intact.”

-Senate Majority Leader Lisa Brown

“When we passed House Bill 2128 in 2008 to improve outreach, enrollment and renewal efforts of the Apple Health program, we hoped this would be the result. We are thrilled. We’ve worked hard over the last three years to get eligible children enrolled in Apple Health, and as a result the number of uninsured children has dropped. This federal bonus is proof that our efforts have been effective; they serve as a model for other states to follow. As I’ve said before, the performance bonus is further proof that we must maintain our commitment to provide all children in the state with comprehensive health coverage in the coming years.”

-State Senator Karen Keiser, Chair, Senate Health & Long-Term Care Committee

“Thanks to Apple Health, even while this severe recession takes a huge toll on our families, more Washington children can see a doctor when they are sick. Apple Health for Kids is making a difference in child health, buying parents some precious peace of mind, and saving taxpayer dollars. This new federal money comes directly from Apple Health’s success, and it should be used to sustain our state’s commitment to cover all kids.”

-State Representative Larry Seaquist

“Apple Health saves money and promotes the stability of Washington families.”

-Rebecca Kavoussi, Assistant Vice President of Government Affairs, Community Health Network of Washington

"We are thrilled that our state has once again received a bonus for outstanding performance in children's health. The additional money should be safeguarded to preserve health insurance for all Washington's children, not diverted to fill the general budget hole.”

-Cassie Sauer, Washington State Hospital Association

“Pediatricians in our state believe that all children deserve quality health care. This federal money will sustain access to care for many children whose families have suffered during our economic downturn. Apple Health for Kids protects children by providing access to preventive health care, immunizations and sick care with their usual medical provider, before they require expensive ER or hospital care.”

-Beth Harvey, MD, FAAP, President, The Washington Chapter of the American Academy of Pediatrics

“I know what it’s like to lie awake at night and worry about a sick child. But thanks to Apple Health for Kids, my son has access to health care and prescription coverage. If the proposed cuts to Apple Health go through, there will be thousands of families forced to bear the agony of having no way to care for their sick children.”

-Tracy Tiwebemal, mother of child enrolled in Apple Health for Kids, Spokane