In Washington State, Medicaid is may be referred to as "Washington Apple Health" or "Apple Health". Medicaid is a health insurance program for low-income individuals and is jointly funded by the state and the federal government. Medicaid covers individuals of all ages.
Washington Apple Health Online Medicaid Application: Washington Connection
Washington Medicaid Long-Term Care Eligibility in 2022
Eligibility for 2022:
1. Residency and Citizenship – the applicant must be a resident of Washington and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than 300% of the Federal SSI Benefit Level ($2,523) to become eligible for Medicaid.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a "look-back" period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
Exempt Assets in 2022 for an applicant in Washington include:
$2,000 or less in cash/non-exempt assets if single.
One home is exempt (equity limit $636,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
One automobile, no equity amount specified.
Irrevocable burial trust, no amount specified.
Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
Spousal Rules for 2022:
Amount of assets the community spouse may retain: The community spouse can keep one-half of countable assets with a maximum value of $137,400. If the community spouse’s assets do not equal the minimum of $55,547, the community spouse is able to retain 50% of the assets from the institutionalized spouse until the minimum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $2,177.50. The maximum amount of income that can be retained is $3,435.00 varying by case, depending on unique living expenses. Washington is an “income first” state, meaning the state limits the right to petition for an increased community spouse resource amount (CSRA) to couples whose combined income fails to meet the community spouse’s income needs. Basically, this means a community spouse can petition for an increased CSRA where there’s an income gap only after factoring in the nursing home spouse’s income first.
Washington has a 5-year Medicaid Look-Back Period that immediately precedes the date of one’s Medicaid application. During this period, Medicaid scrutinizes all past asset transfers to ensure they were not gifted or sold for less than fair market value. If this has been done, Medicaid assumes it was to meet Medicaid’s asset limit. Persons who violate the look-back rule are penalized with a penalty period of long term care Medicaid ineligibility.
5 Year Look-Back
Additional Medicaid Programs
Apple Health (Washington Medicaid) provides a variety of home and community based programs to help qualified persons remain living outside of nursing homes.
Community First Choice Option (CFCO) – Through CFCO, program participants can receive personal care assistance, personal emergency response systems, assistive technology, in-home respite care, and transitional services from residential living back into the community. Program participants are given the option to choose their own care providers, including some relatives.
Medicaid Personal Care (MPC) Program – While many persons receive personal care services via the abovementioned program, some Medicaid participants receive this benefit via MPC. For the most part, MPC has been replaced by CFCO.
New Freedom Program – Program benefits include personal care provided in the home, financial support for home modifications that enable the resident greater independence, and education and training for family caregivers. This program is only available in King and Pierce Counties.
Medicaid Alternative Care (MAC) Program – Intended to support individuals at home and their caregivers, a variety of long-term services and supports are available. This may include coverage for medical alert services, adult day care, home delivered meals, respite care, and transportation.
Specialized Dementia Care Program (SDCP) – A program designed specifically for individuals with dementia that reside in assisted living / memory care residences.
Tailored Supports for Older Adults Program – Provides assistance to both needy individuals and their caregivers. This program is unique in that it is funded by Medicaid, but serves persons who are not financially eligible for Medicaid.
Community Options Program Entry System (COPES) – Participants can receive services at home, in an adult family home, or in assisted living. Waiver benefits may include skilled nursing, meal delivery, adult day care, durable medical equipment, and home modifications.
Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care, and Medicare are combined into a single program. Additional benefits, such as dental care and eye care, may be available.
Medicaid Provides Health and Long-term Care for Millions of Americans
Many Americans need long-term healthcare services. This is due to the high frequency of chronic ailments and disabling conditions. Survey findings from the 2020 Genworth Cost of Care show that the median national charge for a private room in a nursing facility is $105, 850 every year.
This is why Medicaid is the go-to option for a majority of Americans. It covers the largest share of long-term care services and support.
Medicaid allows for the provision of long-term care and support in a variety of settings, including:
Private homes (Adult Family Home) AFH
Assisted living facilities
Senior Care Community Placement Options
Independent Living residents live in a residential setting, engaging in community life while also enjoying the luxuries of private accommodations, usually in an apartment or villa. Independent Living offers amenities and services that simply make life easier than living alone. From housekeeping, meal prep, home maintenance & laundry service. Independent Living Communities also encourage healthy aging with physical fitness classes, travel, educational and cultural opportunities, and the chance to Live Life well with friends that feel more like family. The primary goal is a community with little to no living restrictions.
55+ Active Adult Living
55+ Independent Active Adult Communities options range from the purchase of a home or condo to renting a home, condo, or apartment. These communities provide amenities centered around your lifestyle many of which offer the perfect retreat & escape from the once crazy life you lived. Activities from golf, resort pools, lakes, shopping, Sports Courts, Social Events, Dog Parks, Art Classes & activities provided by the community and surrounding area. Safety & Security is vital to Seniors and many of these 55+ Communities are Gated & have on-site security. Also, the community is maintained & taken care of by the community.
A type of Senior Living designed for people who need various levels of medicine mgmt. and personal care. Living spaces can be individual rooms or apartments. The facilities generally provide a home-like setting and are physically designed to promote the resident’s independence & a safe – somewhat supervised environment with housekeeping, meals & laundry included along with ADLs = activities of daily living including opportunities for socialization, engagement, and activities. Further, the staff is usually available 24/7 to insure the Senior is safe, well taken care of & protected.
Residential Assistant Living
also referred to as
(AFH) Adult Family Home
An assisted living home is for Seniors who would rather live in a smaller, home-like environment. Similar to other senior care facilities, assisted living homes to offer basic personal care and food services. Also, many of these homes provide medical care through mobile medical services or a contract with a registered nurse. However, it’s unlikely that they’ll have any medical staff. These homes are most likely former residential homes that are turned into assisted living businesses. Since it’s a small senior care facility, they only provide care for up to 6 to 8 seniors. In this way, they’re able to offer a more personal and home-like environment for your elderly loved ones. Assisted living facilities offer rooms that may be fully furnished along with a small kitchen area.
Senior Memory Care
Memory care communities usually serve senior adults living with Alzheimer’s disease or another type of dementia. These communities have specially trained staff members who learn about dementia care best practices, and housing options are designed to include elements that combat the challenges that come with cognitive decline. While many well-intentioned family members seek to keep their loved one at home, relocating to a memory care community is often better for both the seniors and their loved ones. When you search for memory care communities, find a place that features a culture of compassion and empathy, specially trained staff, unique programs tailored for seniors with dementia, and a true desire to educate family members.