Understanding the WA Cares Fund
The WA Cares Fund is a public long-term care insurance program designed to provide financial relief for Washington workers needing assistance with daily living activities as they age or if they experience a sudden care need. Funded by a 0.58% payroll premium on employee wages, the program offers a lifetime benefit amount (starting at $36,500 and adjusted for inflation) to cover a wide range of services, such as in-home care, meal delivery, and assistive technology. Unlike traditional insurance or Medicaid, there are no income or asset tests to qualify, making it accessible to a broader population.
Core Eligibility Requirements
To qualify for the WA Cares benefit, individuals must meet two primary criteria: a contribution requirement and a care need requirement.
- Contribution Requirement: Workers must pay into the fund for a certain period, which can be met through one of three pathways. For a year to count as a qualifying year, you must work at least 500 hours (about 10 hours per week) in that year.
- Care Need Requirement: You must be evaluated by the Department of Social and Health Services (DSHS) and determined to need assistance with at least three activities of daily living (ADLs), or require substantial supervision due to cognitive impairment.
The Three Contribution Pathways
The WA Cares Fund offers different paths to earn benefits, accommodating various career timelines and life situations.
- Lifetime Access (10+ years): Most workers will qualify through this pathway. To gain lifetime access to the full benefit, you must have contributed for at least 10 qualifying years without a break of five or more consecutive years in which you did not contribute.
- Early Access (3 of the last 6 years): This path is for workers who experience a sudden care need earlier in their careers. You can access the full benefit if you have contributed for at least three of the past six years at the time you apply for benefits.
- Pro-Rated Benefits (Near-Retirees): Workers born before January 1, 1968, can earn a pro-rated benefit. For each year they contribute to the fund, they earn 10% of the maximum benefit, providing a benefit even if they cannot meet the 10-year requirement.
The Care Need Evaluation
Once the contribution requirements are met, an individual's need for care is assessed by the DSHS. This is not a simple self-declaration; it involves a conversation with a representative and potentially verification by a health professional.
Activities of Daily Living (ADLs) include things like:
- Eating
- Bathing
- Walking or moving around in a wheelchair
- Using the toilet
- Managing medications
- Transferring from a bed or chair
If you need help with three or more of these activities, you meet the care need requirement. In cases of severe cognitive impairment, such as dementia, the need for substantial supervision also counts towards eligibility.
Who is Automatically Excluded or Can Apply for an Exemption?
While most Washington workers are included, there are specific groups who either do not contribute or can apply for an exemption.
- Automatically Excluded: Certain workers, such as federal government employees and most employees of tribal businesses, do not pay into the fund.
- Self-Employed Workers: These individuals are not automatically enrolled but can choose to opt-in to the program to earn benefits.
- Ongoing Exemptions: As of January 1, 2023, ongoing exemptions are available for specific groups. These include:
- Workers living out of state (conditional)
- Workers with a non-immigrant work visa (conditional)
- Spouses or registered domestic partners of active-duty military members (conditional)
- Veterans with a 70% or greater service-connected disability (permanent)
It is important to note that the one-time exemption for those with private long-term care insurance (available until December 31, 2022) is now closed to new applicants. Those who were approved for this exemption remain exempt.
A Comparison of Contribution Pathways
| Feature | Lifetime Access | Early Access | Pro-Rated Benefit |
|---|---|---|---|
| Contribution Requirement | 10+ years (500+ hours/yr), no 5-year break | 3 of the last 6 years (500+ hours/yr) | 1+ years (500+ hours/yr) |
| Target Audience | Most Washington workers | Workers with sudden care needs | Workers born before Jan. 1, 1968 |
| Benefit Amount | $36,500 lifetime benefit (inflation adjusted) | $36,500 lifetime benefit (inflation adjusted) | 10% of full benefit per year contributed |
| Time of Qualification | Anytime after meeting contribution | At time of sudden care need | Anytime after meeting contribution |
The Importance of the WA Cares Fund
For many Washington families, the WA Cares Fund offers a critical safety net, providing financial assistance for long-term care without depleting personal savings or relying solely on programs like Medicaid. By contributing a small percentage of their wages during their working years, individuals gain access to a valuable benefit that can help them age with dignity and maintain independence longer. The program's portability, allowing continued participation for those who move out of state, further extends its value.
Conclusion: Staying Informed on Your Eligibility
The WA Cares Fund was designed to provide an affordable and accessible long-term care solution for Washington's workforce. Understanding who qualifies for WA Cares involves recognizing the specific contribution pathways and the care need evaluation process. It's crucial for individuals to assess their personal situation—whether they fall into one of the exemption categories, are nearing retirement, or need to plan for a potential care event—and stay informed via the official WA Cares website for the most up-to-date information regarding eligibility and benefit access. While the program benefits began to become available in July 2026, staying on top of the requirements ensures you are prepared to access your benefits when needed.
