Medicaid for nursing home and home care in Washington

Who qualifies

You must meet three tests:

1. Age or disability. You are 18 or older with a chronic condition, disease or disability, and you need help with care. Some programs are only for people 55 or older.
2. Care needs. A DSHS social services worker does a CARE assessment (Comprehensive Assessment Reporting and Evaluation) in your home. It looks at eating, dressing, bathing, walking, toileting and other daily tasks. A nurse may help.
3. Money rules. Your income and resources meet the limits below.

Money rules

Limits differ by service, living situation and marital status. HCA posts current figures on its income standards chart.

What counts as a resource

Counted: cash, bank accounts, stocks, bonds, retirement plans, trusts, annuities, life insurance (if the face value is over the small exempt amount), a second vehicle, and land that is not your home.

Not counted: your main home (up to the equity limit), household goods, one car, burial plots, and most prepaid burial plans.

Gifts and transfers: the 60-month look-back

DSHS reviews money or property you gave away or sold for less than it was worth in the 60 months before you apply. Those transfers can make you ineligible for a period of time.

You can transfer your home without penalty to:

• your spouse,
• a child under 21, or a blind or disabled child,
• a sibling who has an equity interest and lived there at least one year, or
• an adult child who lived with you and gave you care for at least two years.

If you are married

• Both spouses' resources are counted at first. Then the spouse at home keeps a share: at least $72,529, and up to $162,660 in some cases. Washington's own minimum is higher than the federal minimum.
• A spousal allowance brings your spouse's income up to at least $2,705 a month, and as much as $4,066.50.
• The state does not place a lien on your home while your spouse lives there.

What you pay: client responsibility

You may have to put part of your income toward your care. This is called client responsibility. Your approval letter shows the amount and what you keep:

• money for personal needs: $108.74 a month in a nursing home; on an HCS waiver at home, up to $2,982 if you are single, or $994 if you have a spouse at home,
• money to keep up your home, if a doctor expects you to return home within six months (the Housing Maintenance Allowance), and
• money for health insurance premiums.

If you live in an adult family home or assisted living, you also pay the facility for room and board.

The main programs

At home

• Community First Choice and Medicaid Personal Care. Pay for help with bathing, dressing, toileting and other personal care. You can hire an Individual Provider whom you manage, or use a licensed home care agency.
• COPES (Community Options Program Entry System). A Medicaid waiver for people 65 and older (or 18 and older and blind or disabled) who need nursing-home-level care, or will within 30 days, and choose to live at home, in an adult family home or in assisted living. It adds services on top of Community First Choice, such as adult day health, home-delivered meals, nursing, home changes, medical equipment and transportation. It does not pay for personal care itself; that comes from Community First Choice.
• Other services: adult day services, home-delivered meals, emergency response systems, home changes, assistive technology and transportation.

For unpaid family caregivers (55 and older)

• Medicaid Alternative Care (MAC). For people 55 or older with an unpaid caregiver. It supports the caregiver instead of paying for personal care. No client responsibility and no estate recovery.
• Tailored Supports for Older Adults (TSOA). For people 55 or older who have more savings than Apple Health normally allows: up to $84,354 for one person, or $156,883 with a spouse at home. Mainly supports unpaid caregivers. No client responsibility and no estate recovery.

Other settings

• Adult family homes (up to eight residents) and assisted living facilities. They must be licensed and accept Apple Health.
• Nursing facilities for 24-hour nursing care, including short rehab stays.
• PACE for people 55 and older in certain ZIP codes in King, Pierce, Snohomish and Spokane counties.

How to apply, step by step

1. Apply. Online at washingtonconnection.org, or on paper with HCA form 18-005, "Washington Apple Health Application for aged, blind, disabled/long-term care coverage." You can get the form from the HCA website or your local Home and Community Services (HCS) office.
2. Gather documents: Social Security number, ID, proof of income, proof of resources, and citizenship or immigration papers if asked. You will also give consent for electronic asset checks.
3. Financial review. DSHS checks your income and resources.
4. CARE assessment. A worker visits your home to assess your care needs.
5. Get your letter. It tells you which services you can get and your client responsibility.

HCS offices:

• Region 1 (eastern Washington): 509-568-3700 or 1-800-459-0421
• Region 2 (King, Snohomish, Island, Skagit, Whatcom, San Juan): 206-341-7600 or 1-800-346-9257
• Region 3 (Pierce, Thurston, Kitsap and others): 253-476-7200 or 1-800-442-5129

Someone else can apply for you if you sign a consent form, which must be renewed each year.

After you are approved

• Reviews. Your money and care needs are reviewed at least once a year, and after big changes.
• Report changes in income, resources, address or living situation to your HCS office.
• If you are denied, your notice explains how to ask for a hearing and the deadline. Free legal help: CLEAR at 1-888-201-1014.

Estate recovery

After you die, the state may recover the cost of LTSS from your estate. It waits while a spouse is alive, or while a child is under 21, blind or disabled. MAC and TSOA are not recovered. Hardship rules may apply.

Common mistakes

• Giving away money or the house without checking the look-back rules first.
• Assuming you have too much money. TSOA allows far more savings than regular Apple Health.
• Missing the home maintenance allowance. If you expect to go home within six months, ask about it.

Free help

• Community Living Connections: 1-855-567-0252 or waclc.org. Links you to your Area Agency on Aging and to family caregiver support.
• SHIBA (free Medicare counseling): 800-562-6900.
• CLEAR legal help: 1-888-201-1014.

Read more about paying for a nursing home and see all benefits in Washington.

Phone numbers: Free help lines for Washington agencies

Check what you may qualify for