Washington Medicaid Definition
In the state of Washington, Medicaid is called Washington Apple Health or simply Apple Health. Medicaid is a health insurance program for low-income, low-asset individuals, and is jointly funded by the state and the federal government. While Medicaid covers individuals of all ages, the focus of this page will be on Medicaid eligibility for elderly Washington residents (65 years of age and older). Furthermore, emphasis will be specifically on long-term care, whether that be provided in one’s home, a nursing home, an adult family home (adult foster care), or an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which Washington seniors may be eligible, and these programs have slightly varying eligibility requirements and benefits. Further complicating eligibility is that the eligibility rules vary for a single individual versus a married couple, and that Washington offers multiple pathways towards eligibility.
1) Institutional / Nursing Home Medicaid – is an entitlement, which means if one is eligible, assistance will be received. Services are provided only in nursing homes.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – only a select number of participants for enrollment. Waiting lists may exist. Services are provided at home, adult day care, adult family home, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled – is an entitlement, meaning anyone who meets the eligibility requirements is able to receive benefits. Services are provided at home or adult day care.
As mentioned above, eligibility for these programs is complicated by the facts that the criteria vary with marital status and that Washington offers more than one pathway towards eligibility. The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from a Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible for Washington Medicaid. More.
|2019 Washington Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,313 / month||$2,000||Nursing Home||$4,626 / month (Each spouse may have up to $2,313 / month)||$3,000||Nursing Home||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,313 / month||$2,000||Help w/ 2 Activities of Daily Living||$4,626 / month (Each spouse may have up to $2,313 / month)||$3,000||Help w/ 2 A Activities of Daily Living||$2,313 / month for applicant||$2,000 for applicant & $126,420 for non-applicant||Help w/ 2 A Activities of Daily Living|
|Regular Medicaid / Aged Blind and Disabled||$771 / month||$2,000||None||$1,157/ month||$3,000||None||$771 / month||$2,000||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. However, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is disregarded. (Learn more about how Medicaid counts income here). There is also a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is the minimum amount of monthly income to which the non-applicant spouse is entitled. As of July 2018, this figure is $2,057.50 / month, and is set to increase again in July 2019. However, based on shelter costs (rent, mortgage, utilities), the spousal allowance may be as high as $3,160.50 / month. (This figure increases each January). This spousal impoverishment rule allows the Medicaid applicant to transfer income to the non-applicant spouse to ensure he or she has sufficient funds with which to live.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the home is valued under $585,000 (in 2019). For married couples, as of 2019, the community spouse (the non-applicant spouse) can retain up to a maximum of $126,420 of the couple’s joint assets, as the chart indicates above. This, in Medicaid speak, is referred to as the Community Spouse Resource Allowance (CSRA).
Medicaid applicants cannot simply give away, or sell assets for less than they are worth, in order to meet Medicaid’s asset limit. To prevent this from happening, the state of Washington has a 5-year Medicaid Look-Back Period. This is a period of 5 years in which Medicaid checks to ensure no assets were sold or given away under fair market value. If one is found to be in violation of the look-back period, a period of long term care Medicaid ineligibility will ensue.
Qualifying When Over the Limits
For Washington residents, 65 and over who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Medically Needy Pathway – If one is over the income limit for Medicaid eligibility, one may still qualify for services via the Medically Needy Pathway given one’s medical bills are high relative to his/her income. In Washington, this program is called the Medically Needy (MN), Medically Needy Program (MNP), and sometimes, a “Spend-down” program. Basically, the way this program works is one’s “excess income,” (one’s income over the Medicaid eligibility limit) is used to cover medical bills, which may include medical transportation, health insurance deductibles, hospital visits, medical supplies, and prescription drugs. In the state of Washington, the spend-down period is either a three or six-month period, based on the decision of the Medicaid applicant. Once an individual has paid his/her excess income down to the Medicaid eligibility limit (met the spend-down) for the period, he/she will qualify for Medicaid services for the remainder of the period. The income and asset limit for this program is the same as the Regular Medicaid / Aged Blind and Disabled: $771 / monthly income for a single individual and $2,000 in assets, and $1,175 / monthly income for a married couple and $3,000 in assets.
Unfortunately, the Medically Needy Pathway does not assist one in spending down extra assets for Medicaid qualification. This means that if one meets the income requirement for Medicaid eligibility, but not the asset requirement, the above program cannot assist one in “spending down” extra assets. However, one can “spend down” assets by spending excess assets on things that are not considered countable, such as home renovations and modifications (wheelchair ramps, chair lifts, new plumbing or heating system), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific Washington Medicaid Programs
Apple Health (Washington Medicaid) covers the cost of nursing home care for all state residents who have a functional need and meet the financial criteria. However, Washington also recognizes that if at all possible, many nursing home qualified persons would prefer to live in their homes. Living at home can actually be less expensive for the state because doing so utilizes family members to provide non-medical care at no cost to the state.
The Community First Choice Option (CFCO) program was designed just for this purpose. Via this program, personal care assistance, personal emergency response systems, respite care, and transitional services from residential living back into the community, are available. Program participants are given the option to choose their own care providers, including some relatives.
While many persons receive personal care services via the abovementioned program, some Medicaid participants receive this benefit through the state’s Medicaid Personal Care (MCP) program. Please note, for the most part, MCP has been replaced by CFCO.
The New Freedom Program was also designed to assist seniors in continuing to live in their homes. Among its benefits are personal care provided in the home, financial support for home modifications that enable the resident greater independence, and education and training for family caregivers.
Washington also has a program called the Nurse Delegation Program, which provides medical training for family caregivers to enable them to perform some of the procedures that might otherwise require a nurse visit. For example, family caregivers may be taught to inject insulin or change catheters.
Washington Medicaid Alternative Care (MAC) program is another option intended to support individuals at home and their caregivers. It includes coverage for medical alert services, adult day care, home delivered meals, and transportation.
Lastly, Washington has the Community Options Program for Entry System (COPES) program for persons who require the same level of care that is provided in a nursing home residence. Participants can receive services at home or in an assisted living residence. A variety of benefits are available via this waiver, including personal care assistance, meal delivery, adult day care, durable medical equipment, and home / vehicle modifications.