Long-Term Care Medicaid in Washington: 2026 Guide

In Washington, Medicaid is called Washington Apple Health. It is overseen by the Health Care Authority (HCA), and long-term care eligibility is handled by the Department of Social and Health Services (DSHS) through its Home and Community Services (HCS) offices. Long-Term Care Medicaid can pay for nursing home care, in-home personal care, adult family homes and assisted living. Washington has its own rule for how much the spouse at home can keep. This guide explains the 2026 rules in plain language.

At a glance: Washington 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with Washington DSHS before relying on them.

What Long-Term Care Medicaid covers in Washington

Nursing home care. Apple Health pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Apple Health pays the rest.

Community First Choice (CFC). This is a Medicaid state plan program, not a waiver, so it is available to everyone who qualifies. It pays for personal care at home or in a residential setting, along with related supports, for people who meet a nursing facility level of care.

COPES (Community Options Program Entry System). COPES is a waiver that adds extra services for people whose needs go beyond what CFC covers. It is for people 65 and older, or 18 and older with a disability, who meet a nursing facility level of care. People on COPES must use at least one waiver service each month. State rules (Washington Administrative Code, chapter 388-106) allow DSHS to keep a COPES waitlist if funding runs short; whether one is in effect can change, so families should apply rather than assume there is a wait.

Residential settings. Washington’s long-term care programs can pay for care in adult family homes and assisted living facilities that contract with DSHS. Medicaid does not pay room and board; the resident pays toward it from their income.

PACE (Program of All-Inclusive Care for the Elderly). For people 55 and older in a PACE service area.

Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA). These separate programs support unpaid family caregivers and people who are not yet on Medicaid. New enrollment in MAC and TSOA has been paused since December 1, 2025, and new applicants are placed on a statewide waitlist.

Who qualifies

A person generally must:

• be 65 or older, or blind or disabled;
• live in Washington and be a U.S. citizen or qualified non-citizen;
• meet the care-needs test. DSHS uses the CARE assessment (Comprehensive Assessment Reporting and Evaluation), done by an HCS or Area Agency on Aging case manager, to decide if you meet a nursing facility level of care;
• meet the income and asset rules below.

Income rules

In 2026, the special income level is $2,982 a month. Whether income above that level can still qualify for nursing home care, and how, depends on the program.

Once you are on Apple Health in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $108.74 a month, and money can be set aside for a spouse at home and for health insurance premiums. People in home care or residential settings keep a larger amount for living costs, and the amount depends on the setting.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable resources, and a married couple $3,000.

Countable resources include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home (equity up to $1,130,000) if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within DSHS rules

Spousal protections

• Assets: DSHS adds up the couple’s countable assets as of the first day of the month the current continuous period of care began. The spouse at home can keep the greater of: half of that total, up to the federal maximum of $162,660 in 2026; or Washington’s state spousal resource standard of $72,529 (effective July 1, 2025). The home, one car and belongings are not counted. After approval, the applicant has until the end of the month of the first regular eligibility review to move assets above $2,000 to the spouse at home. A court order or hearing decision can raise the amount in some cases.
• Income: The spouse at home keeps their own income. If it is below $2,705 a month (from July 1, 2026), part of the applicant’s income can go to them. Extra is allowed for high housing costs, up to $4,066.50 a month.

Look-back and penalties

When you apply, Washington looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($14,759 a month ($485 a day), from October 1, 2026).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $14,759 is about 3.4 months without Apple Health payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in Washington

Washington’s estate recovery program is run by DSHS, through its Office of Financial Recovery.

• What is recovered: the cost of long-term care services and related costs paid by the state for people 55 and older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse or registered domestic partner is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: DSHS can waive or put off recovery in some situations, such as undue hardship.
• Family members and personal representatives can contact the DSHS Office of Financial Recovery with questions.

How to apply

• Online: Washington Connection if you are 65 or older, blind, disabled or on Medicare
• By mail: using the Apple Health application for aged, blind, disabled and long-term care coverage (HCA 18-005)
• By phone: through the HCS intake line for your area, listed on the DSHS website
• In person: at a local Home and Community Services office
• The assessment: after you apply, an HCS or Area Agency on Aging case manager contacts you to schedule the CARE assessment.

After you apply. DSHS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing. The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in Washington

• DSHS Home and Community Services and HCA: Apple Health applications, eligibility and long-term care assessments.
• Area Agencies on Aging and Community Living Connections: local information on long-term care options.
• SHIBA (Statewide Health Insurance Benefits Advisors): Washington’s free Medicare counseling program (SHIP), through the Office of the Insurance Commissioner.
• Washington Long-Term Care Ombuds Program: free advocates for residents of nursing homes, adult family homes and assisted living.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including Washington:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). Washington’s 2026 home equity limit is $1,130,000, which is above the new cap. Washington will have to lower its limit to no more than $1,000,000 by January 1, 2028.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• Washington Community First Choice
• Washington COPES Waiver
• Washington Medicaid Personal Care
• Washington New Freedom Waiver
• Washington Specialized Dementia Care Program
• Washington Medicaid Alternative Care
• Washington Tailored Supports for Older Adults

Frequently asked questions

What is the difference between CFC and COPES? CFC is the main program for personal care for people who meet a nursing facility level of care. COPES adds services when your needs go beyond what CFC covers.

Does Apple Health pay for adult family homes or assisted living? It can pay for care in contracted adult family homes and assisted living facilities. You pay toward room and board.

How much can my spouse keep? The greater of $72,529 or half of the couple’s countable assets, up to $162,660 in 2026, plus the home, a car and belongings. Income of at least $2,705 a month can also be protected.

Is Washington’s home equity limit going to change? Yes. Washington’s 2026 limit is $1,130,000, and federal law requires it to drop to no more than $1,000,000 from January 1, 2028.

How long is the penalty for a gift? Divide the gift by $14,759 to get the number of months. A $20,000 gift would mean about 1.4 months without Apple Health payment for long-term care.

Will the state take my home after I die? DSHS can seek repayment for long-term care paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with Washington DSHS before relying on them.

Sources

• WAC 182-513-1350, resource standards
• WAC 182-513-1355, allocating resources to a community spouse
• HCA, Apple Health income and resource standards
• HCA, Applications for LTSS
• DSHS, Medicaid eligibility and how to apply
• DSHS, Community First Choice Option
• DSHS, Navigating the LTSS System (COPES)
• Washington Connection
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.