Referrals and preapprovals in WA

For some Apple Health (Medicaid) services, you’ll need a referral from your primary care provider (PCP) before getting care.

When to get a referral

You’ll need to get a referral from your PCP before:

Meeting with a specialist.

Going to a hospital for nonemergency care.

Getting certain medicines, tests, and services.

For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.

You don’t need a referral from your PCP for:

Emergency care (for life threatening conditions or severe pain)
Behavioral health or substance use disorder services
Women’s health services such as breast or pelvic exams
Care from an OB/GYN or midwife
Family planning services
Testing or treatment for HIV, AIDS, or other sexually transmitted diseases (STDs)
Tuberculosis screening or follow-up care
Immunizations (shots)