Help paying for care

Adult day centers are daytime programs for adults who need some level of supervision and care but not skilled nursing or rehabilitative therapy. Services typically include personal care, social activities, education, routine health monitoring, therapeutic activities, meals and snacks, transportation coordination, first aid, and emergency care.

Adult day health is a daytime program for adults who need skilled nursing care or licensed rehabilitative therapy. Centers provide skilled nursing services, physical/occupational/speech-language therapy, brief psychological or counseling services, plus the personal care, meals, social activities, and health monitoring offered at adult day centers.

"Apple Health" is Washington's brand name for all state medical assistance programs, including Medicaid. "Classic Medicaid" refers to the non-MAGI Apple Health programs for individuals who are aged 65+, blind, disabled, or in need of long-term services and supports, eligibility uses SSI-related rules instead of Modified Adjusted Gross Income. HCA administers most Apple Health programs; DSHS administers the SSI, SSI-Related, state-funded Medical Care Services (MCS), and Medicare Savings Programs. Apple Health works as secondary coverage to Medicare for dual-eligibles, picking up costs Medicare does not (deductibles, copays, hearing aids, dental). It can also fund long-term services and supports.

Apple Health for Workers with Disabilities (HWD), program code S08, is a Medicaid buy-in program for working adults age 16 or older with blindness or a disability. HWD provides full Categorically Needy (CN) scope of coverage. Unlike most disability-based Medicaid, HWD has no asset test and no upper income limit, eligibility is based on disability status (federal disability requirements) and being employed (full or part time, including self-employment). Enrollees pay a sliding-scale monthly premium that never exceeds 7.5% of total income. American Indians and Alaska Natives are exempt from premiums. While enrolled in HWD, a person may put earnings into a separate designated account that won't be counted toward eligibility for other Medicaid programs.

Apple Health LTSS encompasses the long-term care programs authorized under Washington Medicaid. Per WAC 182-513-1200, LTSS is split between (1) noninstitutional Apple Health LTSS, Community First Choice (CFC), Medicaid Personal Care (MPC), and ALF coverage, for people who meet functional but not institutional status, and (2) programs using institutional or HCB waiver rules, PACE, Roads to Community Living (RCL), Hospice, and the HCB waivers (COPES, Residential Support, New Freedom, etc.). HCA sets eligibility policy under Title 182 WAC; DSHS Aging and Long-Term Support Administration (ALTSA) Home and Community Services (HCS) handles intake, the CARE functional assessment, and case management. Eligibility requires both financial qualification (SSI-related rules with the LTSS Special Income Level) and a functional determination of nursing-facility level of care (or equivalent for waivers). The state may seek estate recovery for LTC services received after age 55.

The Medically Needy (MN) program is a federal- and state-funded Apple Health program for individuals who are aged, blind, disabled, pregnant, or a child with income above the applicable Categorically Needy (CN) limits. MN provides slightly less health care coverage than CN and requires greater financial participation. Enrollees are given a base period (typically three or six months) during which they incur medical expenses equal to the amount their income exceeds the MN income standard ('spenddown'). Once spenddown is met, MN coverage activates for the remainder of the base period. MN is also the path for institutionalized individuals whose income exceeds the LTSS Special Income Level (program codes L95/L99).

Apple Health Medicare Connect is a Medicare Advantage Dual-Eligible Special Needs Plan (D-SNP) offered through HCA's contracted managed care plans. It is designed for individuals who are dually eligible for Medicare and Apple Health (Medicaid), allowing care coordination between Medicare-covered services (primary medical care) and Apple Health-covered services (behavioral health, long-term services and supports, dental, hearing, vision, transportation). The plan integrates benefits across both programs through a single managed care organization.

CCSWW operates a portfolio of HUD-subsidized affordable senior apartment communities for adults aged 62+ across King, Pierce, and Thurston counties. Most properties cap eligibility at 50% of HUD income limits and set rent at 30% of adjusted household income. Onsite social services and partnerships with other providers help residents age in place. Properties: Chancery Place Apartments (Seattle, 85 units), Elbert House (Bellevue, 50 units), Emma McRedmond Manor (Redmond, 32 units), Franciscan Apartments (Burien, 38 units), Kincaid Court (Sumner, 39 units), Sumner Commons (Sumner, 34 units), Tumwater Apartments (Tumwater, 50 units).

Community First Choice (CFC) is a Washington Apple Health state-plan benefit authorized under Section 1915(k) of the Social Security Act, effective 7/1/2015. CFC enables HCA and its contracted entities to deliver person-centered HCBS LTSS to Medicaid-eligible people who meet the institutional level of care under WAC 388-106-0355. Functional eligibility is based on a CARE assessment under chapters 388-106 and 388-828 WAC; authorization is by DSHS Home and Community Services (HCS) or DDA Community Services (DDCS). CFC services include personal care, skills acquisition training, PERS, caregiver management training, and nurse delegation (per WAC 388-106-0270 through 388-106-0295).

Companion services provide routine visits or phone calls to adults who live alone or are homebound. Some companion services also include help with transportation or shopping.

The Community Options Program Entry System (COPES) is Washington's 1915(c) HCBS waiver for adults who meet nursing facility level of care (NFLOC). HCA and ALTSA jointly administer the waiver. A January 1, 2025 amendment (1) adds 6 years of professional/practical social-service experience equivalent to a Social Service Specialist 2 to the qualifications of evaluators/assessors, (2) updates the Adult Day Care service definition so personal-care hours are no longer manually reduced by 30 minutes per hour of Adult Day Care, instead Adult Day Care is accounted for in the CARE Assessment as informal support, and (3) adds a new provider type, Death Doula, in the Client Support Training & Wellness Education service.

Environmental modifications add safety features to the home, such as ramps, grab bars in showers and near toilets, or widened doorways for wheelchairs, so an adult with a medical or disabling condition can adapt safely. The Washington Assistive Technology Act Program (WATAP) helps people find, try out, and acquire assistive technology, including links to low-interest loans.

Home-sharing matching program run by Senior Services for South Sound that pairs older homeowners with renters or housemates for shared housing in Thurston and Mason counties.

Hopelink emergency, transitional, and permanent supportive housing programs serving north and east King County.

Hospice care involves a team of professionals and volunteers who provide medical, psychological, and spiritual care to a dying person and their family. It is normally provided at home but is also available in hospitals and other care settings. Hospice staff are available 24 hours a day to ensure the person is comfortable and pain-free, and to provide counseling and support.

Section 202 Supportive Housing for the Elderly provides capital advances to nonprofit sponsors to develop rental housing with supportive services for very low-income people age 62+, paired with project-based rental assistance contracts that hold tenant rents at 30% of adjusted income. Tenants typically must be 62+ with household income at or below 50% of area median income. Section 202 buildings often coordinate light supportive services (meals, transportation, case management) and are commonly co-financed with LIHTC. The program description URL now redirects to the HUD Multifamily Programs hub.

Section 42 LIHTC is the primary federal subsidy for affordable rental housing. The IRS allocates credits to state housing finance agencies (in WA, WSHFC) which award them to developers. LIHTC properties may legally restrict occupancy to seniors (62+ or 55+ with services) under the federal Housing for Older Persons Act exemption. HUD's LIHTC Database (lihtc.huduser.gov) is the authoritative national inventory of placed-in-service LIHTC properties and can be filtered to identify WA senior-designated buildings.

Medicaid Personal Care (MPC) is a state-plan benefit available to clients who are (1) functionally eligible for MPC services under WAC 388-106-0200 through 388-106-0235 and (2) financially eligible for a noninstitutional categorically needy (CN) or alternative benefits plan (ABP) Apple Health program. MPC fills the gap below the institutional level of care threshold required for CFC and HCB waivers. Services may be provided at home, in a department-contracted adult family home (AFH), or in a licensed assisted living facility contracted to provide adult residential care services.

Medicare is the federal health insurance program. Original Medicare = Part A (hospital insurance) + Part B (medical insurance) and lets beneficiaries use any doctor or hospital that takes Medicare, anywhere in the U.S. (all 50 states, DC, Puerto Rico, U.S. Virgin Islands, Guam, Northern Mariana Islands, American Samoa). Original Medicare beneficiaries can add a separate Part D drug plan and/or buy a Medigap (Medicare Supplement) policy to help cover the 20% coinsurance and other out-of-pocket costs. Medicare Advantage (Part C) is an alternative offered by private health plans that Medicare approves; these bundled plans include Parts A and B and usually Part D, often with extra benefits (vision, hearing, dental), but typically use a network and require prior authorization for some services. They have an annual out-of-pocket maximum, so Medigap is not needed.

Medicare health plans are another way to get Part A (Hospital Insurance) and Part B (Medical Insurance) benefits instead of Original Medicare. There are several types of plans, including Medicare Advantage Plans (Part C). Plans must follow CMS marketing rules when contacting prospective members. Beyond Medicare Advantage, the broader 'Medicare health plans' category includes Medicare Cost Plans, Demonstrations/Pilot programs, and PACE.

Medicare drug coverage (Part D) helps pay for the brand-name and generic prescription drugs Medicare beneficiaries need. It is optional and is offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. Beneficiaries can get Part D either as a stand-alone Prescription Drug Plan (PDP) added to Original Medicare, or bundled into a Medicare Advantage plan (MAPD). Each plan has its own formulary (list of covered drugs) and pharmacy network. Beneficiaries who do not enroll when first eligible and do not have other creditable drug coverage may owe a late enrollment penalty if they join later. Low-income beneficiaries may qualify for Extra Help (Low-Income Subsidy) to lower or eliminate premiums and copays.

Medigap policies are sold by private insurance companies and supplement Original Medicare (Parts A and B) by paying some of the out-of-pocket costs Medicare doesn't cover (copays, coinsurance, deductibles). Medigap plans do NOT include prescription drug coverage, beneficiaries who want drug coverage need a separate Part D plan. There are 10 standardized federal plan letters; the Washington Office of the Insurance Commissioner publishes the list of approved plans and monthly premiums. Washington state law gives consumers stronger switching rights than the federal default: once enrolled in a Medigap plan B through N, you can switch to any other Medigap plan B through N at any time without taking a written health screening; if you have a Plan A you can switch to any other Plan A on the same terms.

The New Freedom waiver, operating since 2005, provides an alternative to nursing home care for older adults, people who are blind, and people with disabilities who live in their own homes and want increased choice and control over their services and supports through a budget-based program. CMS approved the renewal application on September 24, 2024; the renewal is effective January 1, 2025 through December 31, 2029. Renewal changes: (1) expanded the eligible service area to add Spokane, Whitman, Stevens, Pend Oreille, and Ferry counties; (2) revised several performance measures; (3) added a new provider type, Assistive Technology Professional, to the Training and Educational Supports service.

Through the Nurse Delegation Program, a registered nurse trains and authorizes a caregiver to perform certain nursing-type tasks for a Medicaid client at home, in a boarding home, or in an adult family home. This lets people get nursing-level support without requiring a nurse to perform each task directly.

A Personal Emergency Response System (PERS) is an electronic device, typically a wearable button or in-home unit connected to a phone, that lets an adult summon help in an emergency. When activated, staff at a response center contact 911 or take whatever action has been pre-arranged.

PACE is a comprehensive health and social services program for older adults who would otherwise need nursing-home-level care but can still live safely in the community. In Washington, PACE is delivered by Providence ElderPlace, International Community Health Services, and PNW PACE Partners. Participants get coordinated medical care, day-program services, and help with daily activities through a single team.

Remote caregiving lets people who qualify for Washington's long-term care personal care services receive non-hands-on support via secure video. Caregivers help with medication reminders, meal/hydration cues, encouragement with daily routines, behavior interventions, and wellness check-ins. It can be used alone or alongside in-person care. Through 12/31/2025 the service is offered through Catholic Community Services (using a platform called OnScreen). Beginning 1/1/2026, any licensed Washington home care agency may choose to participate.

The Residential Support Waiver (RSW) is Washington's 1915(c) HCBS waiver for clients who need nursing-facility-level care and require enhanced residential services such as Expanded Community Services (ECS), Adult Family Home Specialized Behavior Support Services, Community Stability Supports, and Enhanced Residential Services. A waiver amendment effective July 1, 2025 clarifies that when an LTSS participant is eligible for a service under the Medicaid State Plan (including 1915(i)), they must receive that service through the State Plan rather than through the 1915(c) waiver, services under the waiver supplement, not replace, State Plan services. The amendment also clarifies that recreational opportunities offered by residential providers may be identified in behavioral support plans.

Senior centers are community facilities where older adults gather to share meals, access services, and participate in recreational and educational activities. They are a key entry point for connecting with other in-home and community services.

SHIBA is Washington's State Health Insurance Assistance Program (federal SHIP designation). Trained volunteers provide free, unbiased, confidential one-on-one help with Medicare: understanding Parts A/B/C/D, comparing Medicare Advantage and Medigap (Medicare Supplement) plans, navigating Open Enrollment, choosing prescription drug plans, and applying for Medicare Savings Programs and Extra Help (Low-Income Subsidy). SHIBA does not sell insurance.

Home Based Primary Care provides health care services to Veterans in their home. The program is for Veterans who need team-based in-home support for ongoing diseases and illnesses that affect their health and daily activities. Veterans usually have difficulty making and keeping clinic visits because of the severity of their illness and are often homebound (though that is not required). HBPC also serves Veterans who are isolated or whose caregivers are experiencing burden, and can be used in combination with other Home and Community Based Services.

A Homemaker and Home Health Aide is a trained person who comes to a Veteran's home and helps the Veteran take care of themselves and their daily activities. Aides are not nurses but are supervised by a registered nurse who helps assess daily living needs. The program serves Veterans of any age who need personal care services and ADL help, are isolated, or whose caregivers are experiencing burden. H/HHA services are delivered by an organization contracted with VA and can be used as an alternative to nursing home care or to provide in-home Respite Care for the Veteran and family caregiver. Services may vary by location.

Skilled Home Health Care is for Veterans needing short-term care as they move from a hospital or nursing home back home, and can also provide continuing care for those with ongoing needs. The program covers skilled services such as skilled nursing, case management, physical therapy, occupational therapy, speech therapy, wound care, and IV antibiotics. Care is delivered by a community-based home health agency contracted with VA, and can be combined with other Home and Community Based Services.

Veteran-Directed Care gives Veterans of all ages the opportunity to receive Home and Community Based Services in a consumer-directed way. The program serves Veterans who need personal care services and ADL help (bathing, dressing, fixing meals), are isolated, or whose caregivers are experiencing burden. Veterans receive a managed service budget; with help from a counselor, they develop a spending plan and hire their own workers (which may include family members or neighbors) to support independent living. Locally in WA the program is co-administered with WA DSHS ALTSA (see related slug).

Veteran Directed Care (VDC), formerly known as Veteran Directed Home Services (VDHS), gives veterans the opportunity to decide how to best meet their care needs and manage their service budget. Participants work with a Care Consultant and Financial Management Service to develop a spending plan and hire workers, including, in many cases, family members, to provide personal care and other supports that help them remain at home.

Volunteer Chore Services connects low-income adults with volunteers who help with everyday tasks at home. It is intended to fill the gap for people who can't afford private in-home help but don't meet the financial or functional thresholds for Medicaid-funded long-term care.

WA Cares is a state-run public long-term care insurance program. Most Washington workers contribute automatically through payroll deductions (premiums began July 1, 2023). Self-employed workers can opt in. When a participant needs long-term care, they apply for benefits and a WA Cares team member assesses care needs in person or by phone. Benefits begin July 2026 and cover a wide range of in-home and residential LTC services up to a lifetime cap. Participants who currently have an approved WA Cares exemption cannot qualify for benefits.

WSHFC's Multifamily Housing & Community Facilities division finances affordable rental housing in Washington through a stack of tools: the competitive 9% Housing Tax Credit, the 4% Bond/Tax Credit program (tax-exempt bonds plus 4% LIHTC), PHA Bond/Tax Credit, CBO Partnerships, 501(c)(3) Bonds, and the Land Acquisition Program. Senior-designated developments compete in the same allocation cycles as family housing. WSHFC also administers compliance monitoring (income/rent limits, WBARS, inspections) for properties financed under these programs.