When Medicaid in Washington State Will Pay for a Nursing Home, Assisted Living, or Home Health Care

The average monthly cost of a private room in a nursing home in Washington was over $13,600 in 2024. Anyone who thinks they might need long-term care (LTC) will want to ensure they have a way to pay for that care. For most people, long-term care is paid for using:

• private funds (your own money)
• nursing home (LTC) insurance, or
• Medicaid.

Washington's state legislature has established a groundbreaking public LTC insurance program (the WA Cares Fund), but it is only providing partial LTC benefits to eligible beneficiaries in 2025. Full benefits won't be available until July 2026, and the maximum lifetime benefit is $36,500 (adjusted annually for inflation).

So, while WA Cares Fund benefits can help cover the cost of some of your long-term care needs, it won't pay your nursing home costs long-term. And once you've received the maximum benefit amount, it's gone.

If you can't afford to pay privately, don't have LTC insurance, or you've exhausted your WA Cares Fund benefits, Washington's Medicaid program might pay for your care.

Washington Medicaid for Long-Term Care Services

Medicaid is a medical assistance program funded by the federal and state governments that pays for long-term care for people who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for long-term care Medicaid.

Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care might qualify for Medicaid benefits if they meet the income and resource qualifications of Washington's Medicaid program.

Washington also offers some Medicaid waiver programs that provide services for people who still live at home but would otherwise require a nursing home. These have similar income and asset rules to nursing home Medicaid.

Medicaid Eligibility for Nursing Homes in Washington

Medicaid is a government health insurance program available to people with limited income and resources. If you're 65 or older, blind, or disabled and meet income and resource requirements, Washington's Medicaid program, called Apple Health, provides coverage for nursing home residents under certain circumstances.

To get Apple Health coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide, which could include:

• 24-hour supervised nursing care
• personal care, and
• therapy.

People who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more automatically meet Washington Medicaid's "institutional level-of-care" requirement. (Wash. Admin. Code § 182-513-1320.) That means they can qualify for Medicaid benefits if they also meet the state Medicaid program's income and resource qualifications (see below).

To apply for Medicaid long-term care coverage, you must apply to the Washington Department of Social and Health Services (DSHS), using either Form 18-005 or by completing an online application. Typically, your nursing care facility can assist you with the Medicaid application process or you can apply at your local DSHS office. Before you apply, make sure you meet the eligibility criteria.

Medicaid Income Limits in Washington for Long-Term Care

In Washington, a single person can have a monthly income up to $2,901 in 2025 and qualify for Apple Health-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $5,802 per month in 2025. These LTC income limits are higher than the income limit for those applying for other health care benefits from Medicaid.

If you qualify for Medicaid and live in a nursing home, you'll be expected to spend almost all your income on your care. Washington allows nursing home residents receiving Medicaid to keep only $103.20 per month as a personal needs allowance.

What Income Counts Toward the Medicaid Limit?

In determining your Medicaid eligibility, DSHS considers any income you receive from any source. But when only one spouse of a married couple applies for LTC Medicaid, the income of the non-applicant spouse doesn't count, to ensure the spouse has enough funds to live on.

Additionally, federal law entitles the non-applicant spouse to a minimum monthly needs allowance (MMNA). (42 C.F.R § 435.725(c)(2).) In Washington, the 2025 MMNA ranges from $2,555 to $3,948 per month. If your non-applicant spouse's income is less, a portion of your income can be transferred to your spouse.

Can You Qualify for LTC Medicaid If Your Income Is Over the Limit?

If your income is above the LTC Medicaid limit, you still might be able to qualify for Apple Health if you meet the "medically needy" criteria. To do that, your medical expenses must be higher than the amount of extra income you have.

Washington's "medically needy" program allows people who are 65 or older, blind, or disabled to use their monthly medical bills to "spend down" their income until it meets the income limit. Even unpaid medical bills count toward the spend down.

In 2025, Washington's medically needy income limit is $967 per month (whether you're single or married). After subtracting the amount of your monthly medical bills from your monthly income, if your remaining income doesn't exceed the medically needy income limit, you'll meet the income requirement for Medicaid long-term care.

Medicaid Asset Rules in Washington

Medicaid for long-term care has different resource rules than those for other Apple Health programs. Resources are assets like:

• real property (real estate)
• personal property
• life insurance with a cash value
• vehicles, including motorhomes
• boats
• IRAs and 401Ks
• bank accounts, and
• cash.

Some assets are exempt—meaning Washington doesn't count them toward the LTC Medicaid resource limit. Exempt assets generally include your home (with equity up to $1,097,000 in 2025), household furnishings, one vehicle, and your personal belongings.

Total up the values of your non-exempt assets to determine how much you have in resources. If you're a single person, you can have only up to $2,000 in countable resources. If you're married, your non-applicant spouse at home can keep up to $157,920 worth of countable joint assets.

Washington Home and Community-Based Waivers and Care Options

Besides covering the cost of nursing home care, Apple Health's LTC Medicaid program recognizes that people who qualify for nursing home coverage might prefer to live in their own homes or alternate care environments, such as assisted living residences. Living outside of a nursing facility could be less expensive for the state and more convenient and desirable for the individuals.

So, Washington's Apple Health will also pay for some services for people who can receive the care they need at home or in an adult group care facility. Home and community-based services (HCBS) programs operate through regular Medicaid programs and special HCBS "waiver" programs. These programs can help you maintain your independence—sometimes in your own home—as an alternative to nursing home placement.

Eligibility for Apple Health's Home and Community-Based Waiver Programs

You must meet Apple Health's regular income and asset limits to qualify for home care services provided by regular Medicaid (entitlement coverage). But Washington's HCBS waiver programs don't have the same strict income limit.

Instead, HCBS waiver programs use the same financial eligibility rules that Medicaid uses for long-term care. For a single person in 2025, the limits are:

• $2,901 in monthly income, and
• no more than $2,000 in assets.

Apple Health offers certain Medicaid waiver programs that provide coverage for home and community-based options for those needing nursing home-level care. Other state Medicaid programs are available for those who don't need this level of care.

Community First Choice Option and Medicaid Personal Care

Through Apple Health's Community First Choice Option (CFC) and Medicaid Personal Care (MPC) programs, Medicaid recipients can receive services like personal care assistance and respite care. CFC and MPC also provide personal emergency response systems and transitional services to help participants move out of nursing homes and back into the community.

CFC serves Medicaid recipients who need a nursing home level of care. Washington's Medicaid Personal Care (MPC) program provides similar services for participants who don't need that level of care.

MPC and CFC primarily provide assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as:

• eating
• dressing
• toileting
• bathing
• grocery shopping, and
• meal preparation.

Both CFC and MPC program participants can choose their own caregivers, including certain family members. And because these programs are entitlements under regular Medicaid, there are no waitlists and any eligible applicant can receive services.

Washington's Community Options Program Entry System Waiver

Apple Health also offers a waiver program called the Community Options Program Entry System (COPES). Through the COPES home and community-based services program, individuals requiring nursing home-level care can get care in their homes or alternative care environments.

COPES also provides other support services to help Medicaid recipients successfully transition to independent or assisted living. These supports include coverage for:

• adult day care and assisted living
• case management
• durable medical equipment
• home health care
• certain home or vehicle modifications
• personal emergency response services
• transportation assistance, and
• other transition support services.

Because COPES is a waiver program and not an entitlement program, only a limited number of slots are available, and you might encounter waiting lists to receive services.

Under certain circumstances, program participants can receive assistance simultaneously under CFC and COPES. If you're a Washington resident who needs Medicaid assistance, but you're not sure whether you meet the relevant income and asset limits, you can read more about eligibility and contact the Washington State Health Care Authority for more guidance.

Other Apple Care HCBS Waiver Programs

Medicaid waivers allow state medical assistance programs to target specific groups of eligible Medicaid recipients. Some of Washington's Medicaid HCBS waiver programs target people with certain medical issues and those who live in specific counties.

For example, the Specialized Dementia Care Program (SDCP) covers personal care and other services for patients with dementia who are living in assisted living centers and memory care residences. And residents of King and Pierce Counties can receive assistance through the New Freedom (NF) waiver program, including:

• in-home personal care
• financial help with home modifications, and
• education and training for family caregivers.

Learn how to apply for these and other Apple Care long-term services and support programs through one of the local resources listed on the DSHS resources page or by calling DSHS at 360-725-2300.

Washington MAC and TSOA Family Caregiver Support Programs

Washington's Medicaid Alternative Care (MAC) program provides support to individuals at home and their caregivers, helping recipients continue living in their homes or the homes of relatives. The MAC program has eligibility requirements that apply to you and to your caregiver regarding:

• age
• living arrangement
• function, and
• finances.

Those who are eligible to receive services under the MAC program must choose between receiving those benefits or more traditional LTC services, such as those offered through the COPES and CFC waiver programs.

Through the MAC program, Medicaid-eligible individuals can receive services such as:

• light house cleaning
• grocery shopping and delivered meals
• respite care
• adult day care
• personal emergency response systems, and
• transportation.

Visit the DSHS website for more information about the MAC program, and apply by visiting your local Community Living Connections office.

For those age 55 or older who are "at risk" of needing long-term services and support, and who aren't currently eligible for Medicaid, the Tailored Supports for Older Adults (TSOA) program might provide assistance.

The TSOA program allows for services similar to those available under the MAC program, but it's for non-Medicaid recipients. So, if you need LTC but are financially ineligible for Medicaid, you might want to learn more about TSOA and find out whether you meet program requirements.