Apple Health Long-Term Services and Supports (LTSS)

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.