Apple Health: Washington's Medicaid Program
Apple Health, Washington's version of Medicaid, is the primary payer for nursing home care for residents with low income and limited resources. This program covers the cost of long-term care in a nursing home for those who meet financial and functional eligibility requirements, including financially limited seniors. While Medicaid will cover essential medical and non-medical services, such as personal care assistance and skilled nursing, it's important to note that not all nursing homes accept Medicaid, and those that do may have limited availability.
Financial Eligibility for Apple Health Long-Term Care
Eligibility for Apple Health is based on strict financial requirements for both income and assets. For applicants needing nursing home care, there are specific limits that are periodically updated. For instance, in 2025, a single applicant's monthly income must not exceed $2,901, and their countable assets must be no more than $2,000.
For married couples where only one spouse is applying, income and asset rules are designed to prevent the non-applicant spouse from becoming impoverished. In 2025, the institutionalized applicant spouse has the same income and asset limits as a single person, while the spouse remaining in the community may be able to keep a significant portion of the couple's combined assets.
Functional Eligibility and the Look-Back Period
In addition to financial limits, applicants must demonstrate a functional need for care, specifically requiring a "Nursing Facility Level of Care". This need is determined by an assessment conducted by the Washington Department of Social and Health Services (DSHS).
Medicaid also enforces a 60-month (five-year) look-back period to prevent applicants from giving away assets to qualify. If assets were transferred for less than market value during this period, a penalty period of ineligibility may be imposed.
The WA Cares Fund: State-Funded Insurance
Washington is the first state to create a public, worker-funded long-term care insurance program, known as the WA Cares Fund. This program began collecting premiums from employee paychecks in July 2023, with benefits becoming available starting July 2026. The fund is designed to provide working Washingtonians with affordable access to long-term care coverage, including services in a nursing home, assisted living, or at home.
Benefit Amount and Use
Eligible individuals can access a lifetime maximum benefit of $36,500, which will be adjusted for inflation. While this may not cover the total cost of nursing home care for an extended period, it can provide significant financial relief. The WA Cares fund is intended to offer a valuable supplement that can help cover initial costs or be used to buy time for families to plan for future needs. Benefits can be used for a wide range of services, including in-home care, facility stays, and specialized equipment.
WA Cares vs. Apple Health (Medicaid) for Nursing Home Care
| Feature | WA Cares Fund | Apple Health (Medicaid) |
|---|---|---|
| Funding | Employee payroll tax (0.58%) | State and federal taxes |
| Primary Purpose | Long-term care insurance benefit | Needs-based healthcare and long-term care |
| Benefits Begin | July 2026 | Upon eligibility approval |
| Benefit Amount | Lifetime maximum of $36,500 (inflated annually) | Covers full nursing home costs for eligible residents, less their income contribution |
| Eligibility | Contribution and care needs requirements | Strict income, asset, and functional needs requirements |
| Asset Protection | Not applicable (not a needs-based program) | Allows for spousal protection and other exemptions |
| Look-Back Period | Not applicable | 60 months for asset transfers |
| Estate Recovery | Not applicable | State may recover costs from the deceased beneficiary's estate |
Combining Programs for Maximum Coverage
For many residents, particularly middle-income families, the best strategy may involve combining benefits. The initial payout from the WA Cares Fund could provide immediate assistance, delaying the need to spend down assets to qualify for Medicaid. Once the WA Cares benefit is exhausted, and if financial resources have been depleted, an individual could then transition to Apple Health coverage, providing a more comprehensive long-term solution.
Important Considerations
When planning for nursing home care, it's crucial to understand the limitations and implications of each program. The WA Cares benefit is a capped lifetime amount, and the high cost of care means it may not cover a long-term stay. Medicaid eligibility, though covering more extensive costs, requires a significant reduction of personal wealth and can have estate recovery consequences. Therefore, careful financial and care planning is essential.
Conclusion
In Washington state, residents can receive financial assistance for nursing home care through the state's Medicaid program, Apple Health, and the WA Cares Fund. Apple Health provides comprehensive coverage for those with limited income and assets, while the WA Cares Fund offers a valuable initial benefit for workers who have paid into the system. Given the high cost of long-term care, a combination of these programs, along with personal financial planning, is often necessary to cover expenses effectively.
