Who Pays for Senior Care in Washington State?

Plain-language guide to private pay, Apple Health (Medicaid), and Medicare — with links to official WA sources. As of 2026.

Medicare Myth-Buster: Medicare Does NOT Pay for Long-Term Care

Medicare does not cover custodial long-term care — that means it will not pay for an assisted living community, an adult family home, or a long-term nursing home stay simply because someone needs help with daily activities.

Medicare does cover short-term skilled nursing or rehabilitation after a qualifying hospital stay (generally 3+ inpatient nights). Coverage can last up to ~100 days, but conditions apply and cost-sharing increases after day 20. Once skilled-care needs end, Medicare coverage stops — even if the person can no longer return home.

Source: medicare.gov — Nursing Home Care · Verified 2026

The Three Ways Senior Care Gets Paid

💵 Private Pay

Most people start by paying out of pocket — from savings, retirement income, Social Security, pension, or proceeds from selling a home. Adult family homes, assisted living, and nursing homes all accept private-pay residents.

Costs vary widely by facility type, location, and level of care needed. There are no statewide set rates for private-pay residents. Always ask each facility for a written fee schedule before committing.

🍎 Apple Health — WA Medicaid

Apple Health is Washington State's Medicaid program, administered by HCA (Health Care Authority) with long-term care managed by DSHS ALTSA. For those who qualify financially and medically, Apple Health can pay for care in nursing homes, adult family homes, and assisted living communities. See the full section below for important details and caveats.

🏥 Medicare (short-term only)

As described above, Medicare covers only short-term skilled nursing or rehab — not ongoing personal care or room and board in any residential care setting. If someone is in a nursing home solely because they need help with daily activities and there is no active skilled-care need, Medicare will not pay.

Apple Health (WA Medicaid) for Long-Term Care

Nursing Home Medicaid — an Entitlement

Medicaid coverage for nursing home care is an entitlement in Washington State. This means that anyone who meets the financial and functional eligibility criteria must be offered coverage — there is no waitlist. Care must be provided in a Medicaid-certified nursing home that holds a DSHS contract.

Source: DSHS ALTSA — Nursing Facility Services · Verified 2026

COPES Waiver — Adult Family Homes & Assisted Living

COPES (Community Options Program Entry System) is Washington's main Medicaid waiver program that helps pay for care services in adult family homes, assisted living communities, and at home.

COPES does NOT pay room & board. It covers only the care services portion of the cost. Residents are responsible for room, board, and personal incidentals — typically paid from their own income (Social Security, pension) after a personal-needs allowance is set aside.
COPES is not an entitlement — waitlists can form. Unlike nursing home Medicaid, COPES is a waiver program with limited slots. Eligible individuals may be placed on a waitlist if capacity is full. Contact DSHS ALTSA for current waitlist status.

Sources: dshs.wa.gov/altsa · hca.wa.gov — Long-Term Care · Verified 2026

Eligibility Basics (as of 2026 — verify current figures)

To qualify for Apple Health long-term care, an applicant must meet both a functional need (assessed by DSHS) and financial criteria. Key financial thresholds for a single applicant as of 2026 — always confirm current limits at hca.wa.gov or with a DSHS caseworker:

  • Countable assets: roughly $2,000 or less for a single person (some assets are exempt — see below).
  • Monthly income: approximately $2,900/month or less for a single person (as of 2026; income rules can be complex — verify).
  • 5-year look-back: DSHS reviews asset transfers made in the 5 years before applying. Transfers at below-market value may result in a penalty period.
  • Home is generally exempt while the applicant is receiving benefits and intends to return home, or while a spouse or certain dependents remain in the home. Estate recovery may apply after death.
This is not an eligibility determination. Income, asset, and functional rules are complex and change over time. Only a DSHS caseworker can determine your actual eligibility. Confirm all figures at hca.wa.gov or by calling ALTSA (see below).

How to Start the Process

📞 Call WA ALTSA

Call 1-800-422-3263 to request a free functional needs assessment from DSHS. This assessment determines the level of care you qualify for and begins the eligibility process.

🌐 Apply Online

Apply for Apple Health benefits through Washington Connection — the state's online benefits portal.

🏘 Local Help

Your local Area Agency on Aging and Community Living Connections provide free local guidance, help navigating the system, and referrals to services in your county.

Finding Medicaid-Contracted Facilities

In our directory, a Medicaid ✓ badge means the facility currently holds a DSHS Medicaid contract and can accept Apple Health and/or COPES residents. Always confirm current Medicaid bed availability directly with the facility, as contracted status can change.

Find Medicaid-contracted facilities near me → Medicaid nursing homes →

Use these guides to understand which program applies to your situation and how the family home fits into the picture.

Programs & Benefits: COPES, NH Medicaid, WA Cares, VA A&A → Guide: Should You Sell the Home to Pay for Senior Care? →
Required disclaimer: This page provides general information only — it is not financial, legal, or eligibility advice. Rules, income limits, asset limits, and program availability change. Always confirm your specific situation with WA DSHS ALTSA or the Health Care Authority (HCA) before making any decisions.
Key sources: medicare.gov · dshs.wa.gov/altsa · hca.wa.gov · Page reviewed 2026.