How Do I Apply For Medicaid In Washington State

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What Is Washington Medicaid

Why to consider opting out of Washington state’s Long-Term Care Trust Act – New Day NW

Washington Medicaid pays for low-income residents to receive medical and behavioral care services provided by professionals throughout the state. Known as Apple Care, Washington’s Medicaid program covers a wide variety of services, including preventive care, diagnostic screenings and treatment for acute and chronic illnesses.

Washington’s Medicaid Program Apple Health Will Pay For A Nursing Home Assisted Living Or Home Care If You Have Limited Income And You Need The Appropriate Level Of Care

By Douglas Witten

With the average monthly cost of a private room in a nursing home in Washington approaching $10,000 in 2018, those who are likely to need long-term care should pay serious attention to ensure they have a way to pay for that care. LTC is usually paid for by private funds, nursing home insurance, or Medicaid. In 2019, Washington’s state legislature established a groundbreaking public LTC insurance program, but it will not provide LTC benefits to eligible beneficiaries until 2025. In the meantime, if a patient cannot afford to pay privately and does not have LTC insurance, Washington’s Medicaid program might pay for his or her care.

Medicaid is a medical assistance program funded by the federal and state governments to pay for LTC for persons 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 LTC.

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 may qualify for Medicaid benefits, if they meet the income and resource qualifications of Washington’s Medicaid program.

There are also some limited services for people who still live at home but would otherwise require a nursing home. These are called home-based waiver programs. Similar income and asset rules apply for these programs.

Where Can Medicare Beneficiaries Get Help In Washington

Washingtons State Health Insurance Benefit Advisors

Free volunteer Medicare counseling is available through Washingtons State Health Insurance Benefit Advisors 1-800-562-6900. The program is a State Health Insurance Assistance Program sponsored by the federal government.

SHIPs like SHIBA can help beneficiaries enroll in Medicare, compare and change Medicare Advantage and Part D plans, and answer questions about state Medigap protections. They may also be able to offer referrals to local agencies for services like home care and long-term care. This website has more information about SHIBA in Washington.

Elder law attorneys

Elder law attorneys can help individuals plan for Medicaid long-term care benefits. The National Academy of Elder Law Attorneys has a search feature beneficiaries can use to find an elder attorney locally.

Recommended Reading: What Do I Need To Qualify For Medicaid In Texas

Services Covered By Apple Health

The federal government requires each state Medicaid plan to cover a basic set of services, which are known as mandatory benefits. According to the guidelines, physician services, laboratory tests, X-rays, inpatient hospital care and home health services, among others, must be covered. States are also allowed to cover optional services, such as prescription medications and occupational therapy. The following are some of the services covered by Apple Health in Washington:

  • Hearing aids
  • Services provided by a nursing facility
  • Prescription drugs

How To Apply For Medicaid In In Washington

How Do I...?

In Washington, there are several methods when it comes to applying for Medicaid. That said, you should first find out if you will be able to qualify. You should also make sure that you have the required documentation before you apply. The application is one that is lengthy and to ensure that you get everything done efficiently, you should be prepared. You will need the following things:

  • Proof of the full legal name for each household member
  • Social Security Number for each household member
  • Current address
  • Legal presence papers or citizenship documentation
  • Proof of residency in Washington
  • If you currently have health insurance, you will need information regarding it
  • Any known medical conditions
  • All of these things for each member of the household

People looking to apply for Medicaid in Washington can do so in person, by phone, by mail, or online.

The Washington Medicaid Application can be found at the Washington HealthPlan Finder site for those who wish to apply online. For a paper application to fill out and send in or to take to your local Medicaid office, you can click here. If you decide that you would like to apply by phone , you can call 855-923-4633 and one of the representatives will be able to guide you through the process. Please be sure to have all of the required information handy when you call to ensure that the process is easier and less time consuming for both you and the representative helping you.

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Submit Your Medicaid Application

OnlineApply online at www.wahealthplanfinder.org.

In Person To get application assistance search for a Navigator or Broker via the customer support link at www.wahealthplanfinder.org.

By Mail Print a Medicaid application online from www.wahealthplanfinder.org.Send completed and signed applications to:Washington Health Plan FinderPO Box 946Olympia, WA, 98507

By Phone For information about applying and enrolling in Apple Health/Medicaid, please call the Customer Support Center at 1-855-WAFINDER / 1-855-923-4633.

In addition to your completed Medicaid application, you may be asked to provide other documents, such as: Identification

Washington Copes Medicaid Waivers Program

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How Much Does Medicaid Cost In Washington

Medicaid costs for Washington residents will vary depending on the group you fall into and the plan you choose. Because you have to be low income to even qualify, these costs will not be much. There are a variety of programs that will provide medical service at low costs or even free. The majority of people will have to choose an MCO . Most of the time, all of the services will be included, but some services will be paid through what is known as a fee for service.

Cost and Coverage of Medicaid in Washington There are a variety of programs that provide free or low-cost medical services to people who are eligible. Apple Health offers complete coverage for major medical. Apart from that, there are a few other programs that will come with benefits that are limited.

Washington Home And Community

COFA Islander health care programs & Apple Health (Medicaid) Facebook Live Nov. 9, 2021

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.

Recommended Reading: How Does One Get Medicaid

Washington Medicaid Enrollment Now Exceeds 2 Million People

As a result of Medicaid expansion, total enrollment in Washington Medicaid and CHIP grew by nearly 644,000 people between the fall of 2013 and November 2017. By mid-2021, total enrollment growth since 2013 had increased to nearly 850,000. That was a total enrollment growth of 76%, the sixth-highest percentage increase in the nation. The national average growth in Medicaid/CHIP enrollment was 44%, although that includes the dozen states that had not expanded their Medicaid programs during that timeframe.

Medicaid enrollment has increased during the COVID pandemic. This is due to the widespread job/income losses, as well as the Families First Coronavirus Response Act, which provides additional federal Medicaid funding to states on the condition that people not be disenrolled from Medicaid during the COVID public health emergency. So enrollment has trended upward since March 2020, and that will continue to be the case until the public health emergency period ends.

Total Medicaid enrollment in Washington was 1,965,401 as of May 2021, and had exceeded 2.1 million by October 2021.

Medicaid Spending In Washington

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Medicaid spending in Washington
  • 10Footnotes
  • Washington’sMedicaid program provides medical insurance to groups of low-income people and individuals with disabilities. Medicaid is a nationwide program jointly funded by the federal government and the states. Medicaid eligibility, benefits, and administration are managed by the states within federal guidelines. A program related to Medicaid is the Children’s Health Insurance Program , which covers low-income children above the poverty line and is sometimes operated in conjunction with a state’s Medicaid program. Medicaid is a separate program from Medicare, which provides health coverage for the elderly.

    This page provides information about Medicaid in Washington, including eligibility limits, total spending and spending details, and CHIP. Each section provides a general overview before detailing the state-specific data.

    HIGHLIGHTS

  • Washington expanded Medicaid under the Affordable Care Act in 2014.
  • GovernorJay Inslee expressed support for Medicaid expansion in 2013 when he stated that it is “as close as what you might call a ‘no brainer’ as there is in state government.”
  • Recommended Reading: I Am On Disability Can I Get Medicaid

    How To File Medicaid Applications In Washington By Phone

    Applicants can sign up for Medicaid by phone if they cannot apply for Medicaid online, by mail or in person. A Medicaid application by phone can be helpful for candidates who are disabled and cannot fill out the forms. In addition, to apply for Medicaid by phone is convenient for those who have questions about their personal health and financial circumstances.

    You can apply for Medicaid in the state of Washington over the phone by calling the Washington Medicaid helpline. The Medicaid application phone line is toll-free and is available 24 hours a day. A Medicaid case worker on the other end of the phone will guide you through the process, which will be only partially completed over the phone. Then, the application for Medicaid is sent to the applicantâs home address for final review and signature. Simply follow the instructions on the Medicaid application once it arrives, and send it to the designated address listed on the form.

    Who’s Eligible For Medicaid For The Aged Blind And Disabled In Washington

    Washington Dc Medical Insurance Card

    Medicare covers a great number of services including hospitalization, physician services, and prescription drugs but Original Medicare doesnt cover important services like vision and dental benefits. Some beneficiaries those whose incomes make them eligible for Medicaid can receive coverage for those additional services if theyre enrolled in Medicaid for the aged, blind and disabled.

    In Washington, Medicaid ABD covers exams, cleanings, x-rays, fillings, fluoride, extractions, and several other services for adults. However, Medicaid ABD does not cover dentures or oral surgery.

    Income eligibility: The income limit is $783 if single and $1,175 if married.

    Asset limits: The asset limit is $2,000 if single and $3,000 if married.

    Medicaid spend-down for regular Medicaid for the aged, blind and disabled benefits in Washington

    Applicants who have incomes above the eligibility limit for Medicaid for the aged, blind and disabled can enroll in the Medicaid spend-down program, which allows individuals to qualify for Medicaid by subtracting incurred medical expenses from their countable income.

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    Washingtons Requirements For Medicaid Qualification

    People who are interested in finding out how to qualify for Medicaid will come to find that there are both financial and personal requirements. The state will determine eligibility based on whether or not the household income requirements are met as well as by comparing medical circumstances of the people applying with the guidelines set by the program. Medicaid takes different patient groups and to qualify for the program, you will have to fall into one of the following:

    • Children under 18 who have a household income that falls below the threshold for free or low-cost benefits
    • Pregnant women need to have an income below the Federal Poverty Level . This coverage will end 60 days past the birth of the child.
    • Legal guardians, caretakers, and parents have to reside with children under 18 while also meeting the income requirements
    • Disabled, blind, or aged applicants have to meet both medical and income requirements

    Patients who are disabled might also be eligible for HWD . If they are older than 16 yet younger than 64 they will need to have an income that is less than 220% of the FPL. They will also have a premium that is on a sliding scale and will never be more than 7.5%.

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    For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services Waivers or Waiver Funded Services.

    Read Also: North Carolina Managed Medicaid Plans

    Does Washington Help With My Medicare Premiums

    Many Medicare beneficiaries who struggle to afford the cost of Medicare coverage are eligible for help through a Medicare Savings Program . In Washington, these programs pay for Medicare Part B premiums, Medicare Part A and B cost-sharing, and in some cases Part A premiums.

    • Qualified Medicare Beneficiary : The income limit is $1,064 a month if single and $1,437 a month if married. QMB pays for Part A and B cost sharing, Part B premiums, and if a beneficiary owes them it also pays their Part A premiums.
    • Specified Low-income Medicare Beneficiary : The income limit is from SLMB levels up to $1,276 a month if single and $1,724 a month. SLMB pays for Part B premiums.
    • Qualifying Individuals : The income limit is from SLMB levels up to $1,436 a month if single and $1,940 a month if married. QI pays for Part B premiums.
    • Qualified Disabled Working Individuals : The income limit is $2,127 a month for applicants who live alone and $2,874 a month for applicants who live with another person. QDWI pays the Part A premiums owed by certain disabled beneficiaries who have returned to work.

    MSP asset limits: The asset limit for QMB, SLMB and QI is $7,860 if single and $11,800 if married. QDWIs asset limit is $4,000 for applicants living alone and $6,000 for applicants living with another person.

    Certain assets are not counted including a first home, household belongings, one car, and some prepaid burial plans.

    Where To Apply For Medicaid In Person In Washington

    Apple Health (Medicaid) Eligibility Factors

    Filing Medicaid application forms in person offers both peace of mind and assistance to applicants in need. Where do you sign up for Medicaid if you need help from a professional worker? As long as applicants are 18 years of age, they can visit a local Medicaid office for help.

    Washington Medicaid application forms should first be printed out online, and completed to the best of an applicantâs ability. Of course, if a Medicaid application is giving a candidate any trouble, he or she is encouraged to bring the blank form in for in-person assistance. First, locate a Medicaid office nearby online. Then, call the Medicaid application office to find out when the most ideal time is for a visit. Finally, bring forms for Medicaid application, along with required items to file for Medicaid in person. Do not attempt to apply for Medicaid without identity, income, residency, citizenship and household information handy, or else the Medicaid office may not accept the incomplete health care application upon submission.

    Read Also: Can I Apply For Medicaid While Pregnant

    How To Apply For Medicaid Online In Washington

    Candidates can apply for Medicaid in Washington online if they are 18 years of age or older. Where do you sign up for Medicaid online? File a WA Medicaid application via web by visiting the Washington HealthPlanFinder website. Once there, applicants will be asked to enter required information to create an account.

    To apply for Medicaid online, have the following details handy:

    • The year in which an applicant is seeking coverage
    • ZIP code
    • Estimated household income
    • Pay frequency

    The above information is used to determine the Medicaid eligibility of an interested beneficiary. When a candidate chooses to apply for Medicaid online, the electronic system utilizes personal information and income details to generate estimated results. The web-based Medicaid application forms then produce eligible government-sponsored health plans to join.

    Since the Medicaid online application requires further review, be on the lookout for correspondence regarding true Medicaid eligibility following a Medicaid application submission. Feel free to follow up directly with a Washington Medicaid representative if need be.

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