Monroe residents who can’t afford health insurance may be eligible for coverage through the Washington Medicaid program known as Apple Health. This and other state Medicaid programs provide crucial coverage to economically vulnerable Americans through joint funding by the federal and state governments.
One in five Washington residents are enrolled in the state Medicaid program and receive a range of benefits, including primary, acute and emergency care, ambulance and nonemergency medical transportation, X-rays, laboratory tests, prescriptions and long-term care.
Qualifying for Apple Health for Long-term Care
Washington residents who are American citizens or legal immigrants and have lived in the United States for five years or longer may be eligible for long-term care services through Apple Health if they meet these additional requirements:
- Have been assessed as needing an intermediate or nursing home level of care
- Have a monthly income of $2,313 or less per individual or $4,626 per couple
- Have countable resources of $2,000 or less per person or $3,000 per couple
Income from all sources counts toward the eligibility limits, including wages, Social Security benefits, pensions, retirement plan withdrawals and investment earnings. Some resources are automatically excluded, such as an applicant’s principal home, household goods, personal belongings and one vehicle.
Those who successfully apply for the
Supplemental Security Income program are automatically enrolled in Apple Health with full benefits.
Community First Choice Option Program Apple Health provides coverage for long-term care in a nursing home setting but also offers eligible seniors the alternative of community-based care through the
Community First Choice Option program. This program gives Monroe seniors the choice of receiving supportive services at home or in assisted living or adult residential care facilities. Depending on a participant’s needs, covered services may include:
- Transition assistance to relocate from an institutional nursing home
- Assistance with medication administration
- Respite care
- Blood glucose monitoring and insulin injections by a professional nurse
- Assistive technologies
- Personal emergency response systems
Nursing home care and services provided through the CFCO program are entitlements under Apple Health, so eligible seniors are guaranteed services without a wait due to participation caps.
Monroe seniors can
complete an online application for long-term care services through Apple Health, visit the
Skykomish Valley Community Services office located at 19705 State Route 2, Suite 100 or call (877) 501-2233.
Community Options Program Entry System Waiver Washington Medicaid also offers the
COPES waiver that may help seniors avoid nursing home admission. This home and community-based services waiver provides assistance in an enrollee’s home or assisted living facility. Room-and-board fees aren’t covered by the waiver, but other valuable services are provided, including:
- Case management
- Skilled nursing care
- Assistance with personal care
- Medical equipment and supplies
- Community support services
- Wellness education
- Nonmedical transportation
Monroe residents aged 65 or older who need assistance with at least two daily living activities can apply for the waiver. To qualify, seniors must have $2,313 or less in monthly income and no more than $2,000 in countable assets per person.
The COPES waiver program isn’t an entitlement through Apple Health, so approved seniors may be placed on a waiting list depending on availability.
To learn more about the COPES waiver or apply, Monroe seniors should contact the Snohomish County
Senior Information and Assistance center at (425) 513-1900.