Washington State Medicaid Eligibility Seniors


Does Washington Apple Health Cover Mental Health

Washington Medicaid includes a very comprehensive mental and behavioral health program. You can get coverage for everything from gambling addiction support groups to psychiatric hospital care. Your plan will be with you every step of the way from assessing your needs to case management post-hospital stay.

Memory Care In Washington

More than 100,000 Washington seniors are living with Alzheimers disease. According to the Alzheimers Foundation, that number is expected to grow to 140,000 by 2025, an increase of nearly 28%. Almost 4,000 people died in Washington from the disease in 2017, making it the ninth leading cause of death in the state. The CDC estimates that Alzheimers disease currently impacts five million Americans nationwide, and by 2060, that number is expected to triple to 14 million.

Memory care facilities provide those living with Alzheimers and dementia with care that is tailored to their unique needs. Memory care can take place in its own facility, or as part of a designated wing of another residential care community. Staff members of memory care units or facilities undergo specialized training in caring for those with memory impairment, and the facilities often coordinate social activities and schedules specifically for the needs of those living with Alzheimers or dementia.

This guide will cover the cost of memory care in Washington, financial assistance options for paying for memory care, free memory care resources in the state and a directory of memory care facilities in Washington.

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.

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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.


  • 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.”
  • Medicaid Eligibility In Washington

    Medicaid Financial Eligibility for Seniors and People with Disabilities ...

    You may have heard of Washington Medicaid by its other name Apple Health. Medicaid is a health program that is run by both the state and the federal government together. It is offered to low-income Washington residents so that they are able to get the health services that they need at a low cost or even free. It even provides preventive care such as treatments for diabetes and high blood pressure.

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    Who Meets The Requirements For Medicaid In Washington

    Washington Medicaid eligibility requirements for applicants not only differ by program but also by category. A candidate who is eligible for Medicaid programs targeted at pregnant women may not be eligible for subsidies designated for parents. Finding out how to qualify for Medicaid programs starts with determining the category in which the Medicaid applicant falls. WA Medicaid benefits eligibility groups include minors, adults, pregnant females, caretakers, senior citizens, non-citizens and individuals with blindness or a disability.

    What are the requirements for Medicaid in WA? General Medicaid eligibility requirements include being a U.S. citizen or meeting the immigration requirements of the state. Qualified immigrants include lawful permanent residents, asylum seekers, refugees, conditional entrants, certain trafficking victims and petitioners granted withholding of removal or part of the Cuban-Haitian Entrant Program . However, non-emergency Medicaid benefits can only be sought out by lawful permanent residents of the state who have resided for at least five years. To prove Medicaid eligibility, noncitizens must supply immigration paperwork along with Medicaid applications.

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    Washington Apple Health Dental

    Washington Medicaid pays for dental services for eligible members, but children and adults get different coverage. Kids can get:

    • Cleanings and exams
    • Extractions
    • Orthodontic care when necessary

    Adults can get coverage for all of those services plus front teeth root canals, dentures, oral surgery, gum disease treatment, and nitrous oxide . Adults do not have coverage for crowns, implants, bridges, or orthodontics.

    Why Medicaid Planning Is One Of The Fastest Growing And Most Important Areas Of The Law

    Americans today are living longer than ever before. While this is great news, there is a downside:

    70 percent of us will need expensive long-term care at some point in our lives, and 20 percent of us will require long-term care for five years or more.

    Just how expensive is long-term care? Lets take a look at some numbers:

    • The median cost of nursing home care in Washington for a semi-private room was more than $102,900 per year in 2017. The cost of a private room exceeded $113,000 per year
    • In certain situations, nursing home care costs considerably more, and costs are expected to rise in the future
    • Approximately two out of every three families exhausts their life savings within two years of a family member entering a nursing home

    So are you destined to go broke if you or your spouse needs long-term care? Absolutely not. We can put a number of powerful legal tools and strategies to work on your behalf to prepare in advance for the possibility of needing long-term care in the future. We can even protect your assets if you are already in a nursing home or must enter one in the near future.

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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%.

    Funeral And Burial Funds

    Generally, Medicaid considers the value of any non-refundable pre-paid funeral plan or burial contract exempt. This includes irrevocable funeral trusts in most states. IFT limits vary, but the cap is typically $15,000 or less per spouse. For example, Nebraska sets a max value of $5,372, whereas New York and Michigan are the only two states that do not consider IFTs of any value exempt for Medicaid purposes. Some states also allow applicants to set aside up to $1,500 in an irrevocable pre-need funeral arrangement and/or a revocable burial fund that is considered an exempt asset.

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    Find Out If You’re Eligible For Free Health Insurance

    Find out if you can get free or reduced-cost insurance both are available from Washington Healthplanfinder. To find out which program you’re eligible for, start with the Individual & Families Cost Estimate Calculator.

    Washington Healthplanfinder offers insurance at prices that are based on your income and family size. If your income is too high for Apple Health you could buy one of the insurance plans offered through Washington Healthplanfinder.

    Apple Health is open year-round. Renewal notices are mailed 60 days before coverage expires. Renew online at Washington Healthplanfinder.

    Medicaid Asset Rules In Washington

    Where does all of Medicaid

    Medicaid for LTC has different resource rules than those for other Apple Health programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.

    If you are a single person, you can have only up to $2,000 in resources with a few allowable exclusions such as a car and your home . If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.

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    Washington Medicare Special Needs Plans

    If you qualify for Medicaid and are over the age of 65, disabled, or have either ALS or ESRD, you can enroll in a Dual-Eligible Special Needs Plan . A DSNP is a type of Medicare Advantage plan that can effectively combine your Medicaid and Medicare benefits into one very low or no-cost plan.

    We have licensed Medicare agents in Washington state that can lay out all of your DSNP options and help you figure out which one makes the most sense for you. For help, call 833-438-3676 or send us a message now.

    Who Qualifies For Medicaid In Washington State

    Washington State provides Medicaid for seniors as well as the following groups of people:

    • Blind individuals
    • Disabled individuals

    To apply, applicants must be a resident of Washington State. If you have questions about your eligibility, simply visit the Washington Connection website and click See if I Qualify.

    Recommended Reading: Centers For Medicare And Medicaid Services Login

    Special Needs Trusts Able Accounts And Long

    Assets that are held in trusts for the benefit of the Medicaid applicant may not be countable if the trust meets specific criteria. For assets that originally belonged to the beneficiary, the assets must be placed into a qualified self-settled special needs trust before the disabled beneficiary turns 65. For assets that were gifted through an outright gift or as a bequest from a loved one to a third-party special needs trust, there is no age limit. It is imperative that the trust meet state law criteria, in order to not be counted. This generally requires that the beneficiary not serve as trustee or have the power to direct the distributions of the trust, and that the trust is used to supplement and not supplant the Medicaid benefits the person receives.

    Applying For Apple Health Coverage

    • Online: Visit washingtonconnection.org.
    • Paper application:. Mail the form to the Washington State Department of Social and Health Services : DSHS Community Services Division, P.O. Box 11699, Tacoma, WA 98411-6699.
    • In person: Visit a Community Services Office near you. Visit the DSHS site for locations.
    • Phone: Call DSHS at 1-877-501-2233.

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    Medicaid As A Welfare Program

    Like the federally funded assistance programs for medical and long-term care that preceded it, Medicaid was originally viewed as a program for welfare recipients or for people who had been reduced to welfare-like circumstances by their medical expenses.

    In keeping with its welfare origins, Medicaid eligibility rules are deeply rooted in the rules for the federally funded cash assistance programs . Because the principal categories of recipients in long-term care institutions are elderly or disabled, it is SSI rules that drive Medicaid eligibility rules for these individuals, even though the two programs serve different needs of somewhat different populations.

    From 1965 to 1977, the Federal agency responsible for administering Medicaid was the same agency that administered the AFDC program . In 1977, Federal responsibility for Medicaid was shifted, along with responsibility for Medicare, to the newly established Health Care Financing Administration, which was created to provide a coordinated Federal approach to health care financing and prepare the administrative groundwork for President Carter’s hoped-for comprehensive national health insurance program. However, this shift in responsibility was not accompanied by a rethinking of Medicaid eligibility rules that remained deeply rooted in the federally funded welfare program, SSI and AFDC.

    Current Medicaid Standards For Washington

    Feb 6, 2019 | Articles

    Over 70% of seniors aged 65 years today will need some form of Long-Term Care during their lifetime. Whether it be in the home or at a skilled nursing facility, care is expensive. Costs for Long-Term Care are the number one threat to a seniors financial security.

    Medicaid is a great resource for paying for Long-Term Care, but the rules are complex and change frequently. The following lists the current Medicaid standards for Washington residents as of January 2019, and explains in more detail how you qualify.

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    Penalty Information In Washington For Medicaid

    If a gift of any amount is given in Washington during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in Washington is called a look-back period and it can make an individual not eligible for Medicaid. Medicaid will not pay for care until the penalty period is over. The penalty is calculated by taking the total amount of any gifts given, and dividing it by $ 9,038, which creates a number of months before Medicaid kicks in.

    The average cost of Nursing home care in Washington is $8,973, so penalties can become very costly for a family that has not planned appropriately for Medicaid.

    Mandatory Eligibility For Medicaid

    Income Limits For Medicaid Dc

    States are required to provide Medicaid to recipients of federally matched cash assistance, either SSI or AFDC. The more relevant program to the issue of long-term care eligibility is SSI because virtually all long-term institutionalized persons are aged, blind, or disabled, and are not part of the AFDC-related population. Therefore, the following discussion generally does not consider AFDC rules or families.

    The majority of elderly and disabled Medicaid recipients live in community settings and qualify for Medicaid by virtue of receiving an SSI payment requirements where applicable). Just the opposite is true of Medicaid recipients in institutions, the majority of whom establish Medicaid eligibility under other eligibility provisions because they have too much income to qualify for a cash payment. In 1986, Medicaid served a total of 6.2 million elderly and disabled persons of whom 4.1 million, or 2 out of 3, also received cash assistance. By contrast, a little more than 330,000, or 1 in 5, of the 1.5 million Medicaid recipients of SNF or ICF services were poor enough to qualify for SSI.

    The reduced rate means that institutionalized persons with incomes from all other sources of $50 per month or more do not receive an SSI payment and cannot qualify for Medicaid assistance as members of this mandatory eligibility group.

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    Uncompensated Transfers Of Assets

    States have the authority to deny Medicaid eligibility for a period of time to persons who have disposed of assets for less than fair market value in cases where those assets, if retained, would have made the person ineligible. The State makes the presumption that the individual gave the asset away for the purposes of meeting Medicaid eligibility thresholds, but the individual has the right to rebut that presumption.

    Before the enactment of Public Law 100-360, a State could elect to impose such penalties within broad Federal parameters. The Supplemental Security Income program also imposed penalties on persons who gave away assets without receiving fair compensation. These penalties potentially applied to any SSI or Medicaid recipient in the State, although in practice they were most relevant to persons anticipating entering a nursing home and attempting to qualify for Medicaid as soon as possible while avoiding the depletion of their assets.

    Public Law 100-360 revised SSI and Medicaid rules on transfers of assets such that they target institutionalized persons applying for Medicaid.

    The Supplemental Security Income provisions are essentially replaced with a requirement that the Social Security Administration inform SSI applicants of potential Medicaid penalties and provide information to States about uncompensated transfers of assets by SSI recipients.


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