Washington
What Is Washington Medicaid and Who Is It For?
Washington Medicaid, also known as Apple Health, is a joint federal and state program that provides health coverage to low-income individuals of all ages. This includes seniors aged 65 and older who require long-term care services. These services may be provided in a nursing home, assisted living facility, adult family home, or in the individual’s home.
What Types of Long-Term Care Medicaid Programs Are Available in Washington?
What Is Institutional / Nursing Home Medicaid?
This is an entitlement program, meaning all individuals who meet the eligibility criteria will receive benefits. Services are delivered exclusively in nursing home settings.
What Are Medicaid Waivers / Home and Community Based Services (HCBS)?
These services are not entitlements and may have enrollment caps and waiting lists. They are designed to help people remain in their homes or community settings and delay or prevent nursing home placement.
What Is Regular Medicaid for the Aged, Blind, or Disabled?
This entitlement program guarantees benefits for those who qualify. Services may include personal care assistance and adult day care for eligible seniors.
What Are the 2025 Financial and Medical Requirements for Eligibility?
Eligibility varies by program and marital status. Below is a summary table with income, asset limits, and care requirements:
Type of Medicaid | Income Limit (Single) | Asset Limit (Single) | Care Requirement | Income Limit (Married, both applying) | Asset Limit (Married, both applying) | Care Requirement | Income Limit (Married, one applying) | Asset Limit (Married, one applying) | Care Requirement |
---|---|---|---|---|---|---|---|---|---|
Institutional / Nursing Home | $2,901 / month* | $2,000 | Nursing Home | $5,802 / month* | $3,000 | Nursing Home | $2,901 / month* | $2,000 (applicant) + $157,920 (non-applicant) | Nursing Home |
HCBS Waivers | $2,901 / month† | $2,000 | Nursing Home | $5,802 / month† | $3,000 | Nursing Home | $2,901 / month† | $2,000 (applicant) + $72,529 (non-applicant) | Nursing Home |
Regular Medicaid (ABD) | $967 / month | $2,000 | Help with ADLs | $1,450 / month | $3,000 | Help with ADLs | $1,450 / month | $3,000 | Help with ADLs |
*Most of the beneficiary’s income, excluding personal needs and certain spousal allowances, goes to nursing home care.
†The full income allowance may not be retained depending on living situation.
What Counts as Income and Are There Any Exceptions?
What Types of Income Are Considered?
Income includes wages, Social Security, pensions, IRA withdrawals, and dividends. Certain payments like Holocaust reparations and VA Aid & Attendance benefits are excluded.
How Is Income Treated for Married Couples?
If only one spouse applies for Medicaid, only that spouse’s income is counted. The non-applicant spouse may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA), which is $2,643.75 in WA (as of 7/1/25).
What Assets Are Countable and Which Are Exempt?
What Assets Count Towards the Limit?
Countable assets include bank accounts, investments, and second properties. Exempt assets include a primary residence, household items, a car, and burial funds.
How Are Assets Handled for Married Couples?
All assets are jointly considered. The Community Spouse Resource Allowance (CSRA) allows the non-applicant spouse to retain up to $72,529—or in some cases, 50% up to $157,920.
What Is the Medicaid Look-Back Period in Washington?
Washington enforces a five-year look-back period for Nursing Home and HCBS Waivers. Any gifts or asset transfers below fair market value can result in a penalty of ineligibility.
Is the Home Exempt From Medicaid?
The home is exempt if the applicant or their spouse lives there. Otherwise, a home equity interest cap of $1,097,000 applies in 2025. After death, the home may be subject to estate recovery unless properly protected.
What Medical Criteria Must Be Met?
Applicants must demonstrate a functional need for long-term care. For Nursing Home and Waiver programs, a Nursing Facility Level of Care (NFLOC) is required. For Regular Medicaid, assistance with Activities of Daily Living (ADLs) may suffice.
How Can You Qualify If You Are Over the Income or Asset Limits?
What Is the Medically Needy Pathway?
Seniors with excess income may qualify by spending down on medical expenses. The 2025 Medically Needy Income Limit (MNIL) is $967/month for individuals and couples.
How Can Assets Be Spent Down?
Assets can be converted to non-countable items like home repairs, burial funds, or debt repayment. It’s essential to avoid violating the Look-Back Rule during this process.
What Is Medicaid Planning?
Those over the limits may still qualify through Medicaid Planning strategies with the help of a professional, potentially protecting their home and assets.
What Medicaid Programs Are Specifically Available in Washington?
- Community First Choice (CFCO): Offers personal care and support services; may be self-directed.
- Medicaid Personal Care (MPC): Provides personal care to those who do not require a nursing home level of care.
- New Freedom Waiver: For residents of King and Pierce Counties, provides support for independence at home.
- Medicaid Alternative Care (MAC): Aimed at helping unpaid caregivers and seniors stay at home.
- Specialized Dementia Care Program (SDCP): Offers dementia-specific services in assisted living settings.
- Tailored Supports for Older Adults (TSOA): Supports those not financially eligible for Medicaid but at risk of institutionalization.
- COPES Waiver: Offers home and community-based services, including adult day care and home modifications.
- PACE Program: Combines Medicare and Medicaid benefits into one plan with added services.
- Money Follows the Person: Helps nursing home residents transition back to community living.
How Can Seniors Apply for Washington Medicaid?
Applications can be submitted online through Washington Connection, by calling DSHS at 877-501-2233, visiting a local DSHS office, or mailing the appropriate application. Area Agencies on Aging can also assist with the application process.
What Should Applicants Do Before Applying?
It’s critical to confirm eligibility before applying. Seniors with income or assets over the limit should seek Medicaid Planning services to increase their chances of approval and protect their resources.