Medicaid is the government-funded health plan that provides needy people with access to primary physician care, essential inpatient and outpatient hospital services, X-rays and long-term care. Each state administers its own Medicaid plan, and in Washington, Medicaid is known as Apple Health.
To qualify for Apple Health coverage, seniors aged 65 and older must have a low income and few financial assets. Seniors eligible to receive federal Supplemental Security Income benefits automatically qualify for Apple Health for the Aged, Blind and Disabled. To qualify for long-term Apple Health coverage, all other seniors must:
- Earn no more than $2,313 per month from all sources, including wages, pensions and investments, or
- Earn no more than $4,626 when applying to Apple Health with a spouse, and
- Own no more than $2,000 in assets, or
- Own no more than $3,000 in joint assets when applying with a spouse
Asset Limits
Some specific assets are excluded from the asset limits, including one personal vehicle, clothing and furniture and an irrevocable burial trust.
A home owned by the applicant and/or their spouse is also exempt as long as it’s worth no more than $585,000 and occupied by the applicant and/or their spouse.
Spousal Income and Asset Exemptions
When only one spouse needs Apple Health services, special rules apply to ensure the community spouse has sufficient funds to live on. The income of the community spouse is disregarded, and they’re not expected to pay for the care of the applicant.
Under the Minimum Monthly Maintenance Needs Allowance clause, the applicant can transfer up to $3,160.50 per month to the community spouse to cover shelter costs. This transferred amount is then deducted from the income claimed on the Apple Health application.
The community spouse can also keep all of the exempt assets, such as the couple’s home, one vehicle and household effects. They’re also entitled to up to half of the couple’s joint assets, with a maximum value of $126,420. If the total value of the couple’s joint assets is $55,547 or less, the community spouse can retain all of those assets.
For more information on Apple Health, contact the Washington Healthplanfinder at (855) 923-4633.
Community First Choice
The Community First Choice waiver is a nursing home diversion program designed to allow Apple Health-enrolled seniors remain in a noninstitutional setting, such as home or assisted living, when they’re in need of a nursing home level of care. CFC provides funding for services, such as personal and attendant care, personal emergency response systems and assistive technology.
Participants have the option to self-direct their care by hiring and managing their own care workers who are paid at the usual Medicaid hourly rate. These care workers may include a spouse or other family members.
Community Options Program Entry System
Seniors with Apple Health coverage who need significant help with two activities of daily living or some help with three ADLs may qualify for services and supports through the Community Option Program Entry System (COPES).
COPES allows fragile seniors to age-in-place in a noninstitutional community setting, such as an assisted living facility, by providing many of the services offered in a nursing home. These services are assigned based on the care needs of each senior and may include case management, skilled nursing care, mobility devices, adult day health programming and home-delivered meals.
Seniors can participate in the CFC and COPES program concurrently.
To learn more about COPES and the CFC program, contact Community Living Connections: Southeast Washington Aging and Long-Term Care at (509) 925-8765.