Will Medicare Pay for Assisted Living in Washington?
Medicare will not pay for any form of long-term care, whether the care is received at home or in a facility. Because Medicare is regulated by the federal government, this is true in every state, including Washington.
Here’s what Medicare will usually cover for assisted living residents:
- The cost of physician-ordered physical, occupational, and speech therapy, which residents can often receive onsite in assisted living settings
- Up to 100 days of care in a skilled nursing facility
- Outpatient health care services and some prescription drug costs
Will Medicaid Pay for Assisted Living in Washington?
Medicaid is regulated by both the federal and state governments, which means that its coverage will vary widely from state to state. In most cases, Medicaid will cover the cost of personal and medical care received within assisted living, but it will not pay for the cost of room and board. When it comes to assisted living, Washington state’s Medicaid programs are more expensive than many other states.
How Does Medicaid Help With the Cost of Assisted Living in Washington?
Washington state has a unique Medicaid program, called Apple Health, that covers the full cost of assisted living for Medicaid-eligible seniors through the Community Options Program Entry System (COPES), a Medicaid waiver program. Washington residents eligible for this program will be offered one or more of the following Medicaid service packages for assisted living:
- Adult Residential Care (ARC): This package is for seniors who need some help with medication reminders and activities of daily living (ADLs). Medicaid-eligible residents who qualify for this package are mostly independent but need occasional assistance throughout the day.
- Enhanced Adult Residential Care (EARC): This level of care includes all the services provided in the ARC package, with the addition of occasional nursing care.
- Enhanced Adult Residential Care-Specialized Dementia Care Services: This level of care includes all the services in the EARC package, with the addition of specialized care for dementia.
- Assisted Living: This Medicaid benefit includes a private apartment and some help with medication management and ADLs.
How to Check if You’re Eligible for Medicaid in Washington
To be eligible for Medicaid coverage of long-term care in Washington, you must be 65 years old or older or between the ages of 18-64 and blind or disabled. You must also meet certain criteria based on your financial situation and your degree of medical need.
To find out if you qualify for Medicaid coverage in Washington state, go to the Washington Connection website and follow the directions beneath “See If I Qualify.” According to the website, qualifying questions take about 15 minutes. The “See If I Qualify” page also offers a “See If I Qualify” tutorial video, for those who like a step-by-step visual aid.
How to Apply for Medicaid in Washington
Once you’ve determined that you may be eligible for Medicaid in Washington, it’s time to submit an application. Here’s a guide to get you started:
- First, as an adult aged 65 or over, you will need to apply for Apple Health Classic Medicaid Coverage, which Washington differentiates from Apple Health (Medicaid) coverage.
- Visit the Washington State HealthCare Authority’s application and renewal page. Scroll down to the part of the page, titled “How to apply for or renew Apple Health Classic Medicaid coverage.” There, you’ll see several options for how to apply, including online or in person. You can print a paper application or use the number provided to request one be sent to you.
- If you choose to apply in person, do so through your local Area Agency on Aging (AAA). There, a social worker can work with you directly to help you complete your Medicaid application.
- Be prepared to provide documentation to the social worker who is handling your Medicaid application. These documents may include bank statements, proof of income, residency status, and more.
Other Ways to Finance Assisted Living in Washington
Washington residents who don’t qualify for Medicaid will need to use some form of private pay or long-term care insurance to pay for assisted living. Here’s a list of the personal savings and assets many people use to pay for assisted living in Washington:
- Personal savings: Pension payments, stocks, Social Security benefits, and IRA or 401(k) accounts can be used to cover the cost of assisted living. It’s worth noting that in Washington, withdrawals from retirements are not taxed, nor are public or private pension income. This makes Washington a tax-friendly state for retirees.
- Long-term care insurance: Seniors who hold long-term care insurance policies can be reimbursed for the cost of long-term care. Know the details of your policy, though. Some policies have a 90-day out-of-pocket period before expenses can be reimbursed.
- The value of your home: Proceeds from the sale of your home can be put toward assisted living expenses. Some people also pay for assisted living with a reverse mortgage, which allows you to borrow money using your home as security for the loan. Always check with a trusted financial advisor before signing off on this kind of financial agreement.
Free Assisted Living Resources in Washington
If you or your loved one is looking for high-quality assisted living, Washington has many free resources available to guide you through the process.
Area Agencies on Aging (AAA)
An Area Agency on Aging is a community organization, either public or private nonprofit, designed to serve the needs of all seniors in that region or area. AAA refers to the type of organization, but the names of AAAs will vary by region.
Washington residents can turn to their local AAAs for help with transportation, nutrition support, Medicaid applications, the search for assisted living, and much more.
Veterans Affairs (VA)
Veterans and their families can receive a host of federal benefits, including health care, pension payments, life insurance, and housing assistance. Before checking with your state’s Department of Veterans Affairs, make sure you’re getting the federal benefits you’re entitled to.
At the state level, veterans are also eligible for many services. In the state of Washington, for example, there are four Medicaid- and Medicare-certified Veterans Homes that provide personal care, nursing care, and more.
Social Security Offices
Social Security benefits can help seniors pay for the cost of assisted living. You can apply to start receiving your Social Security benefits as early as age 62. Keep in mind that the longer you wait to start receiving benefits—up to the age of 70—the more your monthly benefit will increase.
You can find a local Social Security office or apply to start receiving your Social Security benefits through the Social Security Administration website.
Community Living Connections
Washington’s Community Living Connections is a state-wide resource offering resources for long-term care, end-of-life care, disability services and supports, health services, and more.
Assisted Living vs Other Types of Care in Washington
While the cost of assisted living is higher in Washington than the national average, there are still several Washington cities±—including Spokane and Walla Walla—where assisted living is close to or below the national average. Still, assisted living isn’t financially feasible for everyone, and it’s not always the right choice for the level of care you need. Work with family members, close friends, and trusted healthcare professionals to determine what kind of long-term care is most appropriate. Here are a few options:
Independent Living: Also called retirement communities, independent living offers older adults housekeeping, three restaurant-style meals per day, and onsite activities such as yoga, walking groups, and outings. Our research showed that all-inclusive fees for independent living in Washington range from $1,839 to $6,000 per month, depending on the facility’s location and the size of the apartment. Personal care services are available in independent living through third-party contractors.
Assisted Living: Assisted living communities offer housekeeping, three communal meals per day, onsite activities, and daily help with ADLs and medication. The average monthly cost for assisted living in Washington is $6,000, and additional fees for personal care services could increase that fee.
Nursing Home: All of the services available in assisted living are also available in a nursing home, with the addition of skilled nursing care provided by RNs. In Washington, the average monthly cost for nursing home care starts at $9,429.
Memory Care: Also called special care units, memory care can be found in both assisted living facilities and nursing homes. The average monthly cost for memory care varies by facility. OUr research found that the cost falls somewhere in between the cost of assisted living care and nursing care, depending on individual needs.
Aging in Place: Staying at home with the help of in-home care is also an option worth considering, especially if you can’t find a residential facility that meets your or a loved one’s needs. Usually, Medicaid will cover in-home care services more readily than it covers the cost of an assisted living facility. In-home care includes:
- Personal companions, or homemakers, provide companionship, light housekeeping, some meal preparation, and help with errands.
- Home health aides assist you or a loved one with ADLs such as bathing and dressing. They will also help with housekeeping and meal preparation.
- In-home nursing services can be administered by a registered nurse (RN) who visits the home. Skilled nursing care is essential for anyone who is aging in place and needs assistance with wound care or chronic illnesses like diabetes.
- Adult day centers provide social activities for older adults during the day while also offering caregivers a break from caregiver responsibilities.
Assisted Living Laws and Regulations in Washington
Assisted living facilities are not regulated by the federal government. Instead, they receive oversight and guidance on the state level. This means that the laws and regulations governing assisted living facilities will vary from state to state. Keep reading for an overview of assisted living regulations in Washington.
Assisted Living Definition and Scope of Care in Washington
According to the NCAL’s 2022 State Regulatory Review, the state of Washington defines assisted living as any home or institution maintained for the purpose of providing housing, basic services, and assuming responsibility for the safety and well-being of its residents.
The NCAL review defines the scope of care for assisted living facilities in Washington according to basic services, optional services, and third-party services.
Scope of Care for Services Provided in Washington Assisted Living Facilities
