Washington Medicaid for seniors and long-term care

Last verified: June 2026

What Washington Medicaid covers for seniors and adults with disabilities

Apple Health covers nursing facility care for seniors and adults who meet functional need criteria (need for nursing facility level of care) and financial eligibility. Washington also operates Community First Choice (CFC), a federal option that provides in-home personal care to eligible members as an alternative to nursing home placement.

• Nursing facility (skilled nursing home) care
• Community First Choice personal care at home
• In-home services: bathing, dressing, meal preparation, medication management
• Adult Day Health services
• Respite care for family caregivers
• Assisted living facility (through CHORE waiver)
• Hospice care (coordinated with Medicare when dual-eligible)
• Durable medical equipment and home modifications
• Transportation to medical appointments

Source: Washington ALTSA long-term care services overview; HCA Apple Health LTSS information.

Financial eligibility for long-term care Apple Health

The income limit for nursing facility Apple Health is 300% of the Social Security Federal Benefit Rate — approximately $2,982 per month as of 2026. Income above this threshold must be applied to the cost of care (patient share/co-pay); Medicaid covers the remainder.

The asset (resource) limit for a single nursing facility applicant is $2,000. The family home is generally exempt during the lifetime of the applicant or their spouse. Prepaid burial plans, one vehicle, and personal property are also typically exempt.

Source: Washington ALTSA financial eligibility standards; 42 U.S.C. § 1396r-5 (spousal impoverishment protections). Verify current figures with ALTSA or an elder law attorney.

Washington's home and community-based waiver programs

Washington offers several 1915(c) waiver programs through ALTSA, providing alternatives to nursing home placement for people who meet nursing facility level of care criteria:

Washington Medicaid estate recovery

Washington participates in estate recovery. The state may seek reimbursement from the estate of a Medicaid member who received long-term care services at age 55 or older. The home is typically exempt during the member's lifetime and during the lifetime of a surviving spouse or disabled child. Contact ALTSA or an elder law attorney for guidance before making estate planning decisions for a family member who receives or may receive Apple Health long-term care services.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. Washington's share of that population is administered through Apple Health (Washington Medicaid). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

Apple Health (Washington Medicaid) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, Washington may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether Washington uses this approach with Apple Health (Washington Medicaid).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through Apple Health (Washington Medicaid) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact Apple Health (Washington Medicaid) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult Apple Health (Washington Medicaid) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. Washington's current CSRA is set by Apple Health (Washington Medicaid) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments