Who qualifies for Washington long-term care? Your guide to WA Cares and Medicaid

Over 70% of Washingtonians will need long-term care services and support in their lifetime. The key to accessing benefits is understanding the eligibility rules for the state's available programs. This guide details who qualifies for Washington long-term care under the WA Cares Fund and needs-based Medicaid programs.

Quick Summary

Qualifying for Washington long-term care involves either meeting the work and contribution requirements for the WA Cares Fund or satisfying the financial and functional eligibility standards for the state's Medicaid (Apple Health) program.

Key Points

• WA Cares vs. Medicaid: The WA Cares Fund is an employee-funded social insurance plan with no financial test, while Medicaid (Apple Health) is a needs-based program with strict income and asset limits.

• WA Cares Vesting: Qualification for WA Cares requires contributing for either 10 years (lifetime access) or 3 of the last 6 years (early access), with partial benefits for those born before 1968.

• Functional Need: Both WA Cares and Medicaid require a demonstration of functional need, typically defined as needing assistance with Activities of Daily Living (ADLs).

• No Spend-Down for WA Cares: Unlike Medicaid, the WA Cares Fund does not require you to spend down your life savings to qualify for benefits.

• Medicaid Asset Protection: The Long-Term Care Partnership Program allows individuals with qualifying private insurance to protect assets from the Medicaid spend-down process.

• Exemptions Exist: Certain groups, such as veterans with high service-connected disabilities or spouses of active-duty military, can apply for exemptions from the WA Cares tax.

Understanding Washington's Long-Term Care Programs

Washington state provides long-term care coverage through two primary avenues: the WA Cares Fund, a state-run social insurance program, and Medicaid (Apple Health), a needs-based program. The eligibility requirements and benefits differ significantly between the two, making it crucial to understand both.

The WA Cares Fund: Eligibility and Benefits

The WA Cares Fund is designed to help Washington workers cover long-term care costs. It is funded by a payroll tax and provides a lifetime benefit (adjusted for inflation). Benefits became available starting July 1, 2026.

To qualify, you must meet both contribution (vesting) and care need requirements. Vesting involves working and contributing for a specific period. There are pathways for Lifetime Access and Early Access, plus partial benefits for those born before 1968. The care need requirement typically involves needing assistance with Activities of Daily Living (ADLs) or having a cognitive impairment. Certain workers are exempt from contributing and ineligible for benefits, including some veterans, non-residents, and spouses of active-duty military.

Washington Medicaid (Apple Health) for Long-Term Care

For those not covered by WA Cares or needing more extensive care, Washington's Medicaid program is an option. It's needs-based with financial and medical eligibility rules. There are limits on income and assets, and a look-back period for asset transfers. Medical eligibility often requires demonstrating a need for a Nursing Facility Level of Care. Washington Medicaid offers various programs providing services in different settings.

The Washington Long-Term Care Partnership Program

This program links state-approved private long-term care insurance with Medicaid, offering asset protection.

Choosing the Right Path for You

Deciding on the best option depends on your circumstances. Here’s a comparison:

Feature	WA Cares Fund	Washington Medicaid (Apple Health)
Funding	Employee payroll tax (0.58%)	Federal and state funds
Financial Test	No	Yes. Strict income and asset limits apply
Access	Contributor-based (10+ yrs or 3 of last 6)	Needs-based (low income/assets)
Benefit Amount	Up to $36,500 (lifetime, inflates)	Varies by program, can be extensive
Look-Back Period	No	60 months for asset transfers
Pre-existing Conditions	Does not exclude individuals	No exclusion based on pre-existing conditions
Waiting Period	Benefits available July 2026	No waiting period; can start immediately if qualified

How to Apply

WA Cares applications are expected to be available online starting July 2026. Medicaid applications can be submitted online or at a local DSHS office. {Link: DSHS website https://www.dshs.wa.gov/esa/community-services-offices/how-apply-services}.

Planning for Your Future

Long-term care planning is crucial. While WA Cares provides benefits, it may not cover all costs. Options include Washington's public programs, private insurance, and the Partnership Program. Consulting professionals is recommended. More information is available on the official {Link: WA Cares Fund website https://wacaresfund.wa.gov/}.

Conclusion

Qualifying for Washington long-term care depends on the rules of the WA Cares Fund or needs-based Medicaid. Each program has specific requirements related to work history, finances, and care needs. Understanding these options helps in planning for future care.

Frequently Asked Questions

What is the WA Cares Fund?

The WA Cares Fund is a state-run long-term care insurance program funded by a payroll tax on Washington workers. It provides a lifetime benefit of up to $36,500 (adjusted for inflation) for qualifying individuals to help cover long-term care costs.

When can I start receiving WA Cares benefits?

Benefits from the WA Cares Fund will become available starting July 1, 2026, for eligible workers who have met the contribution requirements and have a qualifying care need.

How do I meet the WA Cares contribution requirement?

You can meet the vesting requirement in one of three ways: contributing for 10+ years, contributing for 3 of the last 6 years (early access), or, if born before 1968, earning a pro-rated benefit after just one year of contribution.

What are Activities of Daily Living (ADLs)?

ADLs are basic self-care tasks, such as bathing, dressing, eating, using the toilet, and transferring. For WA Cares, you must need assistance with at least three ADLs to be eligible.

What is the difference between WA Cares and Medicaid (Apple Health)?

WA Cares is an earned insurance benefit with no financial test, while Medicaid is a needs-based program with strict income and asset limits. WA Cares benefits are capped, while Medicaid can cover more extensive and ongoing care needs for those with limited resources.

Is the private insurance opt-out for WA Cares still available?

No, the one-time opt-out window for those with qualified private long-term care insurance closed on December 31, 2022. New applicants cannot get this exemption.

Who can be exempted from the WA Cares Fund?

Certain groups, such as veterans with a high service-connected disability, out-of-state workers, spouses of active-duty military, and some visa holders, can apply for exemptions. Self-employed individuals are automatically exempt unless they opt in.