Understanding Medicaid for Long-Term Care in Washington

Medicaid is a joint federal and state program that helps pay for long-term care when a person's own income and assets are not enough to cover it. It is the largest source of funding for long-term care in the United States, and it is often the most misunderstood.

Medicaid vs. Medicare

These are two different programs that sound alike. In short:

• Medicare is health insurance for people 65 and older, paid for by federal payroll taxes. It pays for hospital stays, doctor visits, and short-term rehabilitation. It does not pay for long-term custodial care.
• Medicaid is a needs-based program, jointly funded by federal and state governments. For seniors who qualify, it does pay for long-term care — in a nursing home, adult family home, assisted living, memory care, and even in-home care, for those that choose to be contracted with Medicaid. Not all businesses carry a Medicaid contract.

Many families reach out to us expecting Medicare to cover Mom's Assisted Living stay. It does not. Understanding this early saves heartbreak later.

Who qualifies in Washington

Washington's Medicaid program is called Apple Health. The eligibility rules have three main parts:

1. Medical need. The applicant needs help with enough daily activities that a professional assessment determines they require a nursing-home level of care.
2. Income limits. Monthly income must fall below a state limit (which changes each year — the Washington Department of Social and Health Services publishes the current figure).
   • For people over the income limit, they may still qualify under the Medically Needy Pathway.
3. Asset limits. Countable assets must be below the state limit. Certain assets — a primary home up to a certain equity, one car, personal belongings — are generally not counted.

The rules get more complicated when a spouse is still living at home, when the person has gifted money in the past five years, or when they own a business. This is one of the most common reasons families come to us — to help them understand where they stand.

How to apply

Applications for Apple Health long-term care services are filed with DSHS (Department of Social and Health Services). The process usually includes:

• Filing the initial application online or in person
• A functional assessment by a DSHS-contracted case manager
• Financial verification — usually five years of bank statements and tax returns
• A determination letter, issued within 45–90 days

We are not attorneys, and complex cases — especially those involving gifting, trusts, or business ownership — often benefit from a meeting with an elder-law attorney. We're happy to refer you to attorneys in your area.

What we help with

When a family is exploring Medicaid, we help you:

• Understand whether your loved one is likely to qualify
• Identify communities that accept Medicaid (not all do)
• Plan the sequence — often families pay privately for a period and then transition to Medicaid once assets are drawn down
• Connect with an elder-law attorney if the situation calls for one
• None of this costs your family anything.