Medicaid LTSS · state

Apple Health Long-Term Services and Supports (LTSS)

WA Health Care Authority

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 Home and Community Living Administration (HCLA) 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.

Who qualifies

Adult 18+ who (a) meets nursing facility level of care via the CARE functional assessment, and (b) meets financial limits. Effective 1/1/2026: Medicaid Special Income Level (SIL) = $2,982/mo (300% SSI Federal Benefit Rate). Personal Needs Allowance (PNA) at home = $2,982/mo single or married with ineligible spouse, or $994 with community spouse. Resource limit $2,000 individual; community spouse resource allowance up to $162,660 (federal, 1/1/2026) / $72,529 (state, 7/1/2025). Home equity limit $1,130,000. Citizenship/residency rules apply; state-funded LTC for non-citizens is available under L04/L24 with caseload caps.

What it covers

Personal care (in-home and residential), skilled nursing, adult day health, home-delivered meals, environmental modifications, durable medical equipment, transportation, nursing facility care, hospice, and HCB waiver services. Residential coverage works in adult family homes and assisted living facilities that accept Medicaid. Specific benefit packages depend on the program (CFC, MPC, COPES, Residential Support Waiver, New Freedom, PACE, RCL, Hospice).

Cost

Standards from HCA 19-0096 (Apple Health Income and Resource Standards, April 2026). Estate recovery applies to LTSS services received age 55+.

How to apply

Apply through DSHS Home and Community Services (HCS). Online via Washington Connection or Washington Healthplanfinder (indicate long-term care). Paper application: HCA Form 18-005 (Aged, Blind, Disabled or Long-Term Care). HCS performs a financial review and the CARE functional assessment. Approved in-home clients are typically case-managed by the local Area Agency on Aging (AAA).

Where to get this in Washington

4 organizations deliver this program. Coverage varies, so check the area each one serves.

Aging & Long Term Care of Eastern Washington (509) 458-2509
AAA for the Spokane region; one number connects callers to information, caregiver support, dementia help, Medicaid in-home care, Medicare counseling, and nutrition.
Carina
Technology nonprofit operating an online care matching platform that connects families needing in-home care with verified caregivers, including Medicaid and state-funded Individual Providers in Washington.
Lewis-Mason-Thurston Area Agency on Aging (360) 664-2168
Three-county AAA for Lewis, Mason, and Thurston counties offering caregiver support, in-home services, nutrition, and the Senior Farmers Market produce benefit.
Olympic Area Agency on Aging (888) 571-6559
AAA covering the Olympic Peninsula and southwest Washington coast; offers information & assistance, caregiver support, nutrition, transportation, and Medicaid case management for seniors and adults with disabilities.

Apply by phone

(800) 422-3263

Apply online

www.washingtonconnection.org

Source www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple