Established in 1965 to help needy individuals access basic health services, Medicaid is the federally mandated health plan for low-income seniors, adults with disabilities and children. Mandatory benefits include physician services, hospitalization, medical tests and long-term care.
Medicaid is administered at the state level and may also include state-specific optional benefits, such as case management, rehabilitation, prescription medications and hospice care.
Apple Health Eligibility
Washington’s Medicaid program is called Apple Health and is managed by the Washington State Health Care Authority. To qualify for long-term Apple Health benefits, including home and community-based waiver programs, seniors aged 65 and older must meet income and asset criteria. Those who already receive Supplemental Security Income payments are automatically enrolled in Apple Health.
Single seniors can earn up to $2,313 per month, and couple’s applying together can earn up to $4,626 per month. The asset limit for individuals is $2,000 and $3,000 per couple.
Income from wages, investments, pensions and alimony payments is included, and assets include cash, bank account balances, stocks, bonds and most real estate. A home which the applicant and/or their spouse own and live in is exempt as long as it’s valued at no more than $585,000.
Minimum Monthly Maintenance Needs Allowance
When only one spouse requires long-term Apple Health and the non-applicant (community spouse) has a monthly income below $3,160.50, the minimum monthly maintenance needs allowance rule applies.
Under the MMMNA, the applicant can transfer income to the non-applicant to bring their monthly income up to $3,160.50, and this amount is then deducted from the applicant’s monthly income when determining Apple Health eligibility.
Community Spouse Resource Allowance
The community spouse resource allowance lets a non-applicant spouse keep 50% of the couple’s joint assets, up to a maximum value of $126,420, when one spouse requires Apple Health coverage for long-term care. This is in addition to exempt assets, such as an owner-occupied home, one vehicle and non-revocable burial trusts.
Under the CSRA, if the couple owns less than $55,547 worth of joint assets, the community spouse can keep 100% of those assets.
To apply for Apple Health, contact the Washington Healthplanfinder customer support center at (855) 923-4633.
Community Options Program Entry System
Seniors with Apple Health coverage who are aged 65 or older and need help with at least two activities of daily living may qualify for the Community Options Program Entry System, a Medicaid home and community-based waiver. This nursing home diversion program helps seniors age in place in an assisted living facility by providing services and supports that are similar to those offered in a nursing home.
COPES services include:
- A personal emergency response device
- Adult day health care
- Assisted living
- Home adaptation to improve safety and accessibility
- Skilled intermittent nursing
- Nonmedical transportation
- Mobility devices
- Medical supplies
- Home meal delivery
- Ongoing case management
Note: Personal care services to assist with bathing, grooming and other activities of daily living aren’t provided through the COPES waiver. Personal care services are available through the Community First Program and eligible seniors can participate in both programs at the same time.
To enroll in COPES, seniors must complete a medical and functional assessment performed by a designated evaluator through the Department of Social and Health Services, Home and Community Services. The assessor will determine if the applicant can live safely in the community with the services and supports available through COPES.
Community First Choice Program Community First Choice is an Apple Health program for seniors aged 65 and older living in a community-based setting, such as assisted living, who require personal care services to avoid institutionalization.
CFC services include:
- Personal and attendant care
- Skills training to help seniors develop self-care skills
- Homemaker services
- In-home respite care
The CFC program also funds transition services for seniors currently in a nursing home who would like to move into an assisted living setting. CFC services can be combined with COPES services.
For more information on COPES or the CFC program, contact the Northwest Regional Council’s Senior Information and Assistance Program in Mount Vernon at (360) 428-1301.