Approximately 22% of Washington state residents have no-cost access to essential health services, such as inpatient and outpatient hospital care, primary physician care and long-term care through Medicaid, the national government health protection plan. The program is geared towards people who have low income and few assets who would otherwise be unable to afford health care services.
In Washington, a Medicaid-expansion state, the Medicaid program is called Apple Health. Seniors aged 65 and older who are eligible for Supplemental Security Income benefits may also qualify for the no-cost Apple Health for the Aged, Blind and Disabled.
Qualifying for Long-term Care Apple Health
Seniors aged 65 and older who earn up to $2,313 per month ($4,626 per couple applying together), own no more than $2,000 in countable assets ($3,000 per couple) and need help with two or more activities of daily living may qualify for long-term Apple Health coverage with access to home and community-based service waivers.
Countable assets include all on-hand cash, bank account balances, stocks and bonds and most real estate. Applicants are exempt from claiming irrevocable burial trusts up to $1,500, one personal vehicle and a residential property that they, and/or their spouse, reside.
When only one spouse needs long-term care, special rules are in place to protect the healthy spouse (called the community spouse) from impoverishment.
If the community spouse earns less than $3,160.50 per month, the applicant can transfer their income to their spouse to bring the community spouse’s income up to $3,160.50.
The community spouse can keep up to half of the couple’s joint assets valued up to $126,420 in addition to assets that are Medicaid-exempt.
To learn more about Apple Health enrollment and eligibility, contact Washington Healthplanfinder at (855) 923-4633.
Community Options Program Entry System
Seniors who meet the financial criteria for Apple Health’s home and community-based services may qualify for the Community Option Program Entry System, a Medicaid nursing home diversion program.
COPES pays for additional care services for seniors who need help from another person to perform at least two activities of daily living. These activities may include getting dressed, bathing, using the toilet, eating and/or moving about.
COPES services can be delivered in an assisted living facility and may include:
- Case management
- An emergency call system
- Skilled and intermittent nursing care
- Training to learn self-management skills
- Nonmedical transportation
- Adult day health services
- Medical equipment and disposable medical supplies
- Home delivered meals
The goal of the COPES program is to let seniors live safely in the most-appropriate, least-intrusive setting. Seniors who apply for COPES are evaluated by an assessor from Washington’s Department of Social and Health Services, Home and Community Services office to ensure the applicants’ care needs can be met through COPES services.
Community First Choice Program Apple Health enrollees aged 65 and older who meet the clinical criteria for nursing facility placement may qualify for personal care services provided in an assisted living setting through the
Community First Choice program.
CFC funds personal care services to help seniors age in place in a noninstitutional setting, such as assisted living. Under the CFC, services include personal care services, assistive technology items, personal emergency response system and transition services.
Seniors can be enrolled in the CFC program and COPES concurrently in order to receive the supports they need to remain in an assisted living facility.
To learn more about COPES and the CFC program, contact Snohomish County’s Aging and Disability Services,
Senior Information and Assistance department, at (425) 513-1900 or (800) 422-2024.