Most long-term care in Washington — like everywhere in the United States — is paid for by Medicaid, not Medicare or private insurance.1 Apple Health is the umbrella name for Washington Medicaid, and its long-term services and supports (LTSS) flows through several distinct programs depending on the setting.

The four Apple Health LTC pathways

Washington uses several distinct programs to deliver LTC under Apple Health. The right pathway depends on the setting and the applicant’s needs.

1. Apple Health for Long-Term Services and Supports (LTSS)

The core eligibility category for nursing-home Medicaid and institutional care. Applicants must meet financial limits and be assessed as needing nursing-facility level of care by DSHS Home and Community Services (HCS) staff. The CARE assessment (Comprehensive Assessment Reporting Evaluation) is the Washington standard intake tool.

2. COPES — Community Options Program Entry System

COPES is the Washington home-and-community-based services (HCBS) waiver under §1915(c). It funds in-home personal care, adult day care, environmental modifications, personal emergency response systems, and respite for Apple Health LTSS-eligible residents who would otherwise need nursing-facility care. COPES is the route most Washington families use to keep a parent at home with Medicaid-funded support.2

3. Residential Support Waiver / New Freedom

Smaller waiver programs for specific populations — traumatic brain injury, complex behavioral health, etc. Most readers won’t need these, but worth knowing they exist.

4. Medicare Savings Programs through Apple Health

QMB, SLMB, and QI programs are administered through Apple Health for Washington dual-eligibles. See the Washington Medicare guide for details.

The financial eligibility tests, in order

Income

Washington uses an income cap at 300% of the federal SSI benefit rate — approximately $2,901/month for individual Apple Health LTC applicants in 2026.3 Applicants over the cap can use a special-needs trust arrangement or, in nursing-home settings, the “post- eligibility treatment of income” rules to qualify with appropriate planning. Unlike some states (Florida), Washington doesn’t require a separate Qualified Income Trust for most over-cap applicants.

Assets

The countable-asset limit is $2,000 for an individual applicant. “Countable” excludes:

Countable assets include:

The 60-month look-back

Like every state, Washington applies the federal 60-month look-back to all transfers of assets for less than fair-market value. The penalty is calculated by dividing the value of the transfer by Washington’s monthly penalty divisor — approximately $11,000/month in 2026, updated annually by DSHS.

A $100,000 gift to an adult child produces roughly a 9-month penalty, beginning when the applicant is otherwise eligible for Apple Health LTC. That timing is what makes look-back penalties so painful: the penalty hits exactly when the family most needs Medicaid coverage.

Spousal protections under Apple Health

When one spouse needs LTC and the other doesn’t, the well spouse (the “community spouse”) is entitled to:

Washington’s community-property regime means that before applying these federal protections, DSHS first characterizes assets as community vs. separate. The mechanics produce different outcomes than in common-law states — and the differences are large enough that an out-of-state plan should always be reviewed by Washington counsel before implementation.

WA Cares: the new public LTC benefit running alongside

Washington became the first US state to enact a public long-term-care benefit when the Long-Term Services and Supports Trust Act passed in 2019 (RCW 50B.04). The 0.58% payroll tax began in July 2023; benefit claims begin July 2026.4

Eligible workers can claim up to ~$36,500 in lifetime WA Cares benefits to pay for a defined menu of care services — in-home care, AFH, assisted living, transportation, meal delivery, equipment, environmental modifications. Eligibility requires meeting work-contribution thresholds (typically 10+ years lifetime or 3 of the most recent 6 years) and meeting an Activities of Daily Living trigger (needing help with at least three ADLs).

Three things to know:

The Individual Provider system — paid family caregiving

Washington allows Apple Health LTSS recipients to hire family members (other than spouses) as paid caregivers through the Individual Provider (IP) program. The IP is employed by DSHS and represented by SEIU 775. Hourly rates are set in the Collective Bargaining Agreement (~$20–$25/hour in 2026 depending on training tier and region) and family members must complete training, background checks, and ongoing certifications.5

For families where an adult child is providing significant care, the IP system is the right structure: payments are legitimate income (not gifts in look-back analysis), come with health benefits and Social Security credits, and avoid the documentation problems of informal arrangements.

What to do this quarter