Does Medicaid Pay For Assisted Living In Washington State

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Wa Will Take Care Of You When Youre Old Heres How

How To Find Medicaid Assisted Living Facilities in Washington State

The state is reportedly the first in the nation to provide a long-term care benefit, which will help pay for nursing care for the old and infirm.

Bob Davis, 78, receives a shave from Yakima Neighborhood Health Services’ Jeannette Villanueva, a registered nurse and respite-housing case manager at a respite unit in Yakima, Washington.

Adriana Hutchings was 33 and pregnant with her first child when her mothers health began to deteriorate. Suddenly, Hutchings was faced with a choice: helping care for her mother in Olympia, or continuing her life and career in Seattle. Ultimately, Hutchings left her business-development and marketing job to move south and assist her mother. The move allowed her to also care for her grandmother, who lived with Hutchings’ mom at the time and suffered from dementia.

That was 2003, and the beginning of 14 years Hutchings would spend as a full-time caregiver not just for her mom and grandma, but also for her father, who fell ill later.

I was really happy to do it, but it was a strain, Hutchings recalled this week. And in the meantime, I was starting to have my own family. Juggling that with taking care of my elders was really difficult.

She said the situation would have been easier if her family members had the resources to hire part-time caregivers, as well as to install ramps and lifts at home to help them get around more easily.

What Is The Basic Difference Between Institutional And Noninstitutional

Institutional Medicaid has different income standards and rules for initial eligibility and higher resource standards for a couple when only one needs institutional services.

Institutional also has a 2nd eligibility component called “post-eligibility treatment of income”. This 2nd eligibility computation determines the amount the individual must pay toward their cost of care to the medical institution or to the HCB Waiver provider. This is called “participation”.

Noninstitutional Medicaid does not have a “post eligibility” component, therefore individuals living in the community on noninstitutional Medicaid do not “participate” toward the cost of their personal care.

MPC individuals do not pay “participation” but they are responsible to pay room and board when living in an alternate living facility.

Alternative State Payments For Assisted Living Expenses

States offer a broad range of alternative coverage for seniors that are not part of the typical Medicaid program. These payments are provided through alternative programs that allow for the waiver of some federal rules such as income eligibility. Most seniors who apply for these waivers must exhibit care needs equivalent to a senior who lives in a nursing home in order to qualify.

Alternative payment programs also have a limited number of spots available, often significantly fewer than Medicaid. Because the waiting list is quite common and lengthy, many seniors will apply well in advance of their actual needs. Support programs differ from region to region and not all programs may be available to seniors statewide. Make sure to ask your enrollment officer about alternative programs available for their location when researching assisted living communities to join.

There are also other non-traditional assistance programs that are available for specific groups of seniors. For example, veterans or the surviving spouse of a veteran have special programs available to help defray the cost of assisted living. Many religious groups and organizations also offer funding for long-term care or have assisted living facilities for seniors that operate on a not for profit model.

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Overview Of Washington Assisted Living

Assisted living in Washington State affords seniors breathtaking scenery, comfortable residences and convenient access to some of the best hospitals and medical facilities in the country.

Washington state assisted living communities are also required by law to meet quality measures that set healthcare standards in Washington above assisted living care in other parts of the country.

Reporting Abuse And Neglect

Does Medicare Pay for Assisted Living or Nursing Homes?

Any staff member who suspects that a resident has been abused, neglected or exploited must file a report with the Aging and Disability Services Administration Complaint Resolution Unit hotline at 562-6078. Online reports may also be filed at the Washington State Department of Health and Social Services website. If a staff member suspects that a resident has been physically or sexually abused, a report must also be filed with a local law enforcement agency.

Also Check: What State Has The Best Medicaid Benefits

Assisted Living In Washington Defined

Adults or seniors who live in Washington assisted living facilities receive food, lodging and help with personal and health-related tasks such as help with daily dressing, teeth and hair brushing, washing, meal preparation and managing medications. This type of personalized assistance is not usually offered at a retirement community or independent living facility. Homes that provide assisted living services to less than 10 residents at a time are known in Washington as adult family homes. You can find Adult Family Homes in our Care Homes category.

However, seniors residing in assisted living in Washington receive less care than at a skilled nursing facility, also known as a nursing home. Nursing homes in Washington are residential treatment facilities where on-site doctors and nurses provide 24-hour supervised medical and rehabilitative care to patients with chronic illnesses. You can find nursing homes in Washington in our Nursing Homes category.

What About Medicare And Medicaid

Right now, Medicaid doesnt cover long-term care for people unless they have very few assets or savings.

Having a home, savings or income from a pension is enough to make many people exceed Medicaids strict income requirements, said McGill, the governors policy adviser.

Meanwhile, Medicare doesnt cover long-term care needs at all.

That has meant that many seniors have to spend down all of their assets before being able to access long-term care support through Medicaid. About 11 percent of people in Washington who apply for Medicaids long-term care assistance fall into this category, according to the states analysis.

Under the current system, We basically expect people to spend themselves into poverty before they can get any long-term care, said state Rep. Laurie Jinkins, D-Tacoma, the prime sponsor of the new law. That will change under the new long-term care program, she said.

What I think it will do for people will be transformative, she said.

Read Also: How To Get Copy Of Medicaid Card Online

State Pay For Caregivers Frequently Asked Questions

  • To get paid by the state for care, you can do so through Medicaid, other state programs, or VA benefits. To get started, youll want to contact your states Medicaid office.

Amie Clark

Amie has been writing about senior care products and services for the last decade. She is particularly passionate about new technologies that help improve the quality of life for seniors and their families. Seeing her parents and grandparents age made Amie ask herself, Would this be good enough for my loved ones? In her spare time, Amie enjoys outdoor adventures and spontaneous road trips. Learn more about Amie here

Information

Determining Your Medicaid Eligibility In Spokane Valley

Do Medicare or Medicaid Pay for Assisted Living | Senior Living with Syed

It can be difficult for you to determine whether you meet the eligibility requirements for Medicaid. The website can be unintuitive and confusing to navigate, leaving you with more questions than answers. If you are thinking about your long-term care planning options and you want to have a clearer understanding of what types of financial assistance are available to you, reach out to a knowledgeable long-term care planning attorney who can walk you through your options. Before you commit to a long-term care plan, you need to be certain that youll be able to afford it. Let your attorney assess the specifics of your situation so that you can plan for a future that youll be able to enjoy, both emotionally and financially.

Interested in learning more about Medicaid Eligibility requirements in the Spokane Valley area? Contact Legacy Law Group today at 315-8087 to speak with a dedicated elder law and long-term care planning attorney.

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Washington Home And Community

Apple Health covers nursing home care for Washington residents who meet applicable financial and functional need criteria, as described above and determined by the Washington DSHS. Washington’s Medicaid program structure also recognizes, though, that individuals who qualify for nursing home coverage might prefer to live in their 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, for various reasons.

Therefore, Medicaid “waiver” programs will also pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These programs can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.

The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. Thus, in 2019 an individual applicant cannot have monthly income greater than $2,313, and the applicant’s assets are limited to $2,000.

Under certain circumstances, program participants can receive assistance simultaneously under CFCO and COPES. If you are a Washington resident who needs Medicaid assistance but are unsure whether you meet the relevant income and asset limits, you can read more about eligibility and consult the Washington State Health Care Authority for more guidance.

What States Pay Family Caregivers In 2021

Nearly every state offers some form of pay for family caregivers however, each of them has different criteria for this financial support. Making matters more complicated, funding for family caregivers can come from a variety of sources, including Medicaid state plans, employer-paid leave programs, home and community-based services , and self-directed programs.

Eligibility and pay for family caregiving may vary from state to state, so its best to reach out to your states health or Area Agency on Aging for more information. In this article, Ill go over some of the common funding sources and services that can assist family caregivers.

Pro Tip: Medical alert devices help provide peace of mind to both caregivers and individuals that need assistance with daily living tasks. To learn more about this technology, check out my picks for this years best medical alert system.

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The Cost Of Assisted Living In Washington

The monthly cost of assisted living in Washington State averages $5,500, which is considerably more expensive than the national average of $4,051. The cost gap is even wider with the neighboring state of Idaho , and nearby Montana and Nevada . Southern neighbor Oregon is closer in cost at $4,400 per month, but there remains no doubt that assisted living costs in Washington clearly outstrip the expenses in all nearby states.

  • Washington State: $5,500
  • Oregon: $4,400

The Cost of Assisted Living in Washingtons Top Cities

Though the monthly state average cost for assisted living is high, the price is even higher in Washington’s largest city of Seattle, where the median average is $6,500. Other nearby cities are considerably less costly, with Spokane costing $4,000 per month, Tacoma coming in at $4,723 monthly, Vancouver’s monthly expense at $4,998 and Yakima costing $5,000 monthly. Overall, the pattern is that assisted living grows more expensive the closer one is in the state to the major urban center at Seattle, but even the lower threshold of costs is only just below the national average.

  • Seattle: $6,500
  • Yakima: $5,000

Senior Cost Care Comparisons in Washington

  • Assisted Living: $5,500

Medicaid Assisted Living And Spotty State Regulations

Will Medicare pay for a nursing home stay?

About half of assisted living facilities are Medicaid-certified to accept Medicaid funds. The money goes toward help with the activities of daily living and other services. Medicaid doesn’t pay residents’ rent, but residents can use SSI to partially or fully pay that expense.

  • Medicaid assisted living qualifications and coverage vary by state depending on factors such as your age, marital status, where you currently live, and your income and assets.
  • Many states cap the dollar amount that a Medicaid-certified facility can charge, and it’s similar to SSI rates.
  • Medicaid waiver programs are waivers from regular program requirements. Among other things, waiver programs can raise income thresholds to let higher-income seniors qualify for assistance. However, these programs have limited slots and may cover only certain regions of a state.
  • Waiver programs can end. A new program may or may not replace an older one.
  • Alabama, Kentucky, Maine, Pennsylvania and Virginia have Medicaid programs that don’t pay anything for assisted living . However, these states may have Medicaid programs that help seniors stay at home or receive care in a residence such as an adult foster home.

Read Also: Medicaid Exclusion List By State

Home Care Waiver Programs

Pennsylvania also operates several Medicaid Waiver programs that provide home health care services to low-income Pennsylvanians.

To qualify for any of Pennsylvania’s Waiver programs, you must meet the nursing home level of care. In addition, you must have income less than $2,163/month and fewer than $8,000 in resources. To apply for waiver programs, contact the Office of Long-Term Living Helpline at 866-286-3636.

Paying For Assisted Living With Medicaid And Medicare

Seniors will typically need to pay a deposit on top of their monthly fees for assisted living. There are several ways to pay for assisted living. Seniors may use long-term care insurance, self-payment, or even a community benefit. Although Medicare wont cover the cost of assisted living care, Medicaid may cover some of the costs. Seniors are able to use a mix of payment options to pay for their stay and if eligible, state Medicaid will cover some of these expenses.

Medicaid pays fully for nursing home stays due to the fact that the caregivers provide skilled nursing and other medical-related services. With assisted living, there is not always a need for skilled nursing or even medical care. As a result, Medicare provided by the state is unable to pay for a senior’s room and board directly and Medicaid is not required to pay for a seniors stay in an assisted living home.

Assisted living communities offer rooms that cost approximately half of that of a nursing home room that is semi-private. States understand that offering assistance to seniors who opt to reside in an assisted living community over nursing home will save on Medicare costs in the long run.

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Free Assisted Living Resources In Washington State

The National Aging and Disability Resource Center program, or ADRC, is designed to streamline access for older adults and the disabled of all ages to long-term care and housing. ADRCs serve as an integrated point of entry for families seeking information and access to all the various services, benefits and supports relevant to their long-term care needs or the needs of loved ones. Its mandate is to build strong partnerships with local community organizations, aging and disability advocates, and healthcare providers, and to provide personalized counseling and support to members of the public.

Contact: For further information about the state’s ADRC program, call 725-3548 or e-mail

The Washington State Long-Term Care Ombudsman Program advocates for the residents of long-term care facilities, including assisted living facilities, to ensure that they enjoy high-standard and quality care and are not subjected to abuse, neglect or exploitation. The program receives and resolves complaints about quality-of-care and works to educate families, residents, caregivers, facility staff and the public at large about residents’ rights.

Contact: The program can be reached by email at and by phone at 562-6028.

Contact: Call 352-3304 or the toll-free line at 562-6170.

Medicaid’s Benefits For Assisted Living Facility Residents

Difference between Skilled Nursing and Assisted Living? Does Medicaid pay for Assisted Living?

Assisted living facilities are a housing option for people who can still live independently but who need some assistance. Costs can range from $2,000 to more than $6,000 a month, depending on location. Medicare wont pay for this type of care, but Medicaid might. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents.

Unlike with nursing home stays, there is no requirement that Medicaid pay for assisted living, and no state Medicaid program can pay directly for a Medicaid recipients room and board in an assisted living facility. But with assisted living costs roughly half those of a semi-private nursing home room, state officials understand that they can save money by offering financial assistance to elderly individuals who are trying to stay out of nursing homes.

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City, State

As of 2019, 44 states and the District of Columbia provided some level of financial assistance to individuals in assisted living, according to the website Paying for Senior Care, which features a State by State Guide to Medicaid Coverage for Assisted Living Benefits that gives details on each states programs. According to the website, the Medicaid programs of Alabama, Kentucky, Louisiana, Maine, Pennsylvania, and Virginia are the only ones that provide no coverage of assisted living, although non-Medicaid assistance may be available.

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What Is Medical Care Services

MCS is a state funded medical program used for legally admitted non citizens that do not qualify for a Classic or MAGI Medicaid program because they are in their 5 year bar for federal Medicaid.

MCS covers nursing home and HCS has a state funded residential program for individuals eligible to receive MCS.

MCS does not cover MPC or HCB Waiver.

Pennsylvania’s Medically Needy Program

You may also qualify for Medicaid through Pennsylvania’s Medically Needy Program. In the Medically Needy Program, you can use medical bills, including nursing facility bills, that you incur each month to “spend down” your income and qualify for Medicaid Needy Only Medicaid.

The MNO income limit is $425/month, meaning that you must show that you have incurred medical expenses each month that would leave you with no more than $425. When you apply, your county assistance office will estimate your income and expenses for six months and see whether your adjusted income is less than $2550 . The actual or anticipated cost of a long-term care facility for a six-month period is an allowable expense to qualify for MNO Medicaid.

For example, Mrs. Smith is 70 years old. Her income is $3,500/month, but she lives in a nursing home that charges $7500/month. She is not eligible for NMP Medicaid because she is over the income limit of $2,250/month, but she is eligible for MNO Medicaid because her medical expenses exceed her income. She will be allowed to keep a monthly personal needs allowance of $45, but she will have to contribute all of her other income to the cost of the nursing home. Medicaid will pay the remaining balance. If she has a dependent or a spouse remaining in the community, the state will allow her to set aside some income for their support.

Recommended Reading: Moving To Another State Medicaid

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