Washington Medicaid Income & Asset Limits for Nursing Homes & In-Home Long Term Care

Last updated: July 05, 2022

 

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 individuals and is jointly funded by the state and the federal government. While Medicaid covers individuals of all ages, the focus of this page is Medicaid eligibility for elderly Washington residents (65 years of age and older). Specifically, the emphasis is 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.

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

 

Income & Asset Limits for Eligibility

There are several different Medicaid long-term care programs for which Washington seniors may be eligible. These programs have varying eligibility requirements and benefits. Further complicating eligibility is that the eligibility rules differ for a single individual versus a married couple and that Washington offers multiple pathways towards eligibility.

1) Institutional / Nursing Home Medicaid – This is an entitlement program; Anyone who is eligible will receive assistance. Services are provided only in nursing homes.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; There are only a select number of participant enrollment slots. Waiting lists may exist. Intended to delay and prevent the need for nursing home care, services are provided at home, adult day care, in an adult family home, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged, Blind, Disabled – This is an entitlement program; Anyone who meets the eligibility requirements is able to receive benefits. Various long-term care benefits, such as personal care assistance or adult day care, may be available.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a WA Medicaid program. Alternatively, one can take the Medicaid Eligibility TestIMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Washington Medicaid.  More.

2022 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 $2,523 / month* $2,000 Nursing Home $5,046 / month ($2,523 / month per spouse)* $3,000 Nursing Home $2,523 / month for applicant* $2,000 for applicant & $137,400 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $2,000 Nursing Home $5,046 / month ($2,523 / month per spouse)† $3,000 Nursing Home $2,523 / month for applicant† $2,000 for applicant & $59,890 for non-applicant Nursing Home
Regular Medicaid / Aged, Blind, Disabled $841 / month $2,000 Help with ADLs $1,261 / month $3,000 Help with ADLs $1,261 / month $3,000 Help with ADLs
*All of a beneficiary’s income, with the exception of Medicare premiums, a personal needs allowance of approximately $75.36 / month, and potentially a spousal income allowance for a non-applicant spouse, must go towards nursing home costs.
†A program beneficiary may not be able keep all of their monthly income. After paying Medicare premiums and a spousal income allowance (if applicable), they may only be entitled to a monthly personal needs allowance. The amount of the allowance may vary based on the setting in which the applicant lives and their marital status.

 

What Defines “Income”

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. Covid-19 stimulus checks and Holocaust restitution payments do not count as income and have no impact on Medicaid eligibility.

When only one spouse of a married couple applies for nursing home Medicaid or a Medicaid Waiver, only the income of the applicant is counted. The income of the non-applicant spouse is disregarded and has no impact on the applicant’s income eligibility. However, the non-applicant spouse (also called a community spouse) may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse. The MMMNA is a spousal impoverishment rule and is the minimum amount of income a non-applicant spouse is said to require to avoid poverty. The MMMNA is $2,289 (effective 7/1/22 – 6/30/23). If a non-applicant spouse’s income is under $2,289 / month, income can be transferred from their applicant spouse, bringing their income up to this level.

In Washington, a non-applicant spouse can further increase their spousal income allowance if their housing and utility costs exceed a “shelter standard” of $687 / month (effective 7/1/22 – 6/30/23). However, in 2022, in no case can a spousal income allowance put a non-applicant’s monthly income over $3,435. This is the Maximum Monthly Maintenance Needs Allowance. More on how the spousal income allowance is calculated.

Income is counted differently when only one spouse applies for Regular Medicaid; The income of both the applicant spouse and the non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.

 

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. Medicaid also considers many assets to be exempt (non-countable). Exemptions include personal belongings, household furnishings, an automobile, irrevocable burial trusts, and generally one’s primary home. For home exemption, the Medicaid applicant must live in the home or have intent to return and have a home equity interest no greater than $955,000 (in 2022). Equity interest is the amount of the home’s value owned by the applicant. The home is also exempt, regardless of the above circumstances, if the applicant has a spouse living in it.

 While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s estate recovery program. Following a long-term care Medicaid beneficiary’s death, Washington’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which a senior is applying. However, the non-applicant spouse of a Medicaid nursing home or Medicaid Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). In 2022, the community spouse (the non-applicant spouse) can keep 100% of the couple’s assets, up to $59,890. If the applicant spouse is in a nursing home, the community spouse may be able to retain a higher amount of assets. If the couple’s assets are greater than $119,780, the non-applicant spouse is entitled to 50% of the couple’s assets, up to a maximum of $137,400.

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.

 Non-Financial Eligibility Requirements – For Washington long term care Medicaid, an applicant’s functional need is considered. For nursing home Medicaid and Medicaid Waivers, a nursing facility level of care (NFLOC) is required. Some program benefits may have additional eligibility criteria specific to that benefit. For example, for a Waiver to cover the cost of a personal emergency response system, it may be required that one need it to safely live in their home. For long-term care services via the Regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

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 – Washington has a Medically Needy (MN) or Medically Needy Program (MNP) that allows seniors who have income over Medicaid’s limit to qualify for Medicaid if they have high medical expenses. Sometimes called a Spenddown program, one’s “excess” income is used to cover medical bills. This may include medical transportation, health insurance deductibles, hospital visits, medical supplies, and prescription drugs. The amount one must “spend down” is the difference between one’s monthly income and the medically needy income limit. This can be thought of as a deductible. In 2022, the medically needy income limit in WA is $841 / month for a single senior applicant, as well as for a married couple. The spend-down period is either three or six months, based on the decision of the Medicaid applicant. Once one has their spenddown, they are income eligible for Medicaid services for the remainder of the period. The medically needy pathway has an asset limit of $2,000 for an individual and $3,000 for a couple. More about the medically needy pathway.

2) Asset Spend Down – Persons who have assets over Medicaid’s asset limit can still qualify for Medicaid by spending down extra assets. This can be done spending countable assets on things that are exempt (non-countable). Examples include making home renovations and modifications (wheelchair ramps, chair lifts, new plumbing or heating system), prepaying funeral and burial expenses, and paying off debt. One must be cautious when “spending down” assets to avoid violating Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof this rule was not violated.

Our free spend down calculator is invaluable in assisting persons in determining if they might have a spend down, and if so, providing an approximate figure. Use our spend down calculator.

3) 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 these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible and to protect their home from Medicaid’s estate recovery programRead more or connect with a Medicaid planner.

 

Specific Washington Medicaid Programs

In addition to nursing home care, Apple Health (Washington Medicaid) provides a variety of home and community based programs to help qualified persons remain living outside of nursing homes.

1) 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.

2) 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.

3) 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.

4) 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.

5) Specialized Dementia Care Program (SDCP) – A program designed specifically for individuals with dementia that reside in assisted living / memory care residences.

6) 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.

7) 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.

8) 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.

 

How to Apply for Washington Medicaid

Seniors can apply for Apple Health online at Washington Connection, by calling the Department of Social and Health Services (DSHS) at 877-501-2233, or by mailing a completed paper application (Washington Apple Health Application for Aged, Blind, Disabled / Long-Term Care Coverage). The mailing address is on the application and differs based on the Medicaid program for which one is applying. Alternatively, seniors can apply in person at their local DSHS office. One’s local Area Agency on Aging office may be helpful in answering program questions or assisting with the application process.

Prior to applying for Apple Health benefits in Washington, senior applicants should be positive that they meet all eligibility requirements (as discussed above) for the program for which they are applying. Having income and / or assets over the limit(s), or being uncertain if eligibility criteria are met, can result in a denial of Medicaid benefits. Persons in these situations should seriously consider Medicaid planning for the best chance of acceptance into a Medicaid program. For general information about applying for long-term care Medicaid, click here.

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