Washington Medicaid COPES Waiver: Eligibility and Benefits

Page Reviewed / Updated - Mar. 2015

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

As of July 1, 2015, COPES has largely been replaced by Washington's new Community First Choice Option. However, the information which follows is still relevant for services not redundant with the new program.

The Community Options Program Entry System, or COPES for short, is a Washington State Medicaid (Apple Health) program designed to enable individuals who require nursing home level care, to receive that care in their home or community living environment such as an assisted living residence.  This program provides not only care but also other supports to enable independent living or assisted living.  These include coverage for home modifications to increase safety and access, personal emergency response services to reduce supervision and transportation assistance to get medical appointments and for other errands.

 Under COPES, family members can be compensated for providing caregiving assistance.

COPES also allows for consumer or participant direction. Based on the Medicaid Cash and Counseling model, this means the individual receiving care services under this waiver has the option of self-directing their personal care. In other words, they can choose their personal care provider instead of having the state assign one. Included among the persons eligible to provide personal care are certain family members such as the adult children.  Spouses, however, are ineligible to be paid caregivers under COPES. Medicaid, however, decides the caregiver’s wage, not the family.  This rate ranges from approximately $11 / hour to $15.

 Did You Know? Seniors in Washington who chose to age in place are eligible for free quotes for bathroom safety modifications such as the addition of a walk in tub.  Read more.

 

Eligibility Guidelines

In addition to requiring assistance with two or more activities of daily living or nursing home level care, individuals must be financially qualified for Medicaid. This is a complicated process involving a review of a family’s income, assets and asset transfers as far back as 5 years.

Washington Apple Health Medicaid waivers have an individual income limit in 2015 of $ 2,199 / month.  There is a countable asset limit in 2015 of $2,000.  However, both these limits have some flexibility for a variety of reasons.  Persons with higher incomes may qualify as "medically needy" should they have extraordinarily high recurring medical expenses, such as medications or home health care.  Married applicants have the option of separating joint income if one spouse is not applying for Medicaid under the spousal income allowance.

Assets limits are flexible in that many assets are not counted or consider exempt.  For example, the value of one's home and primary vehicle are exempt as are certain funeral related expenses or trusts.  In the situation where one spouse of a married couple is applying for Medicaid and the other is not, the maximum amount of resources  that the couple can have $119,220 plus $2,000 in 2015.   This is called the Community Spouse Resource Allowance and it is designed to help allow the healthier spouse to continue to afford to live independently.

Washington state residents that are in need of assistance from Medicaid but cannot meet these limits should consider working with an Apple Health qualification expert to understand their options and help them restructure their financial assets to meet the eligibility limits.  Read more about this option here.

 

 

Benefits and Services

Individuals approved for the COPES Waivers can receive any of the following services. Case-by-case approval may be required.

  • Adult Day Care / Adult Day Health Care
  • Assisting Living / Adult Family Homes
  • Durable Medical Equipment
  • Environmental Accessibility Modifications to one's Home or Vehicle
  • Home Care / Home Health Care
  • Home Delivered Meals
  • Hospice Care
  • Personal Care*
  • Personal Emergency Response Services*
  • Transportation Assistance

*These services will only be available until July 1, 2015 after which time they will be moved to Washington's Community First Choice (CFC) Program.

How to Apply / Learn More

This program is available statewide across Washington. However, it is worth noting that the COPES Waiver is not a Medicaid entitlement program. There are a defined number of spots available, approximately 30,000 and waiting lists may exist for services.  Persons on a waiting list are prioritized by date of application as well as the severity of their need.   One can apply or find more information online at the following webpage.

 Assistance is available to help Washington seniors find affordable home care and assisted living.  If applying for Medicaid, be sure to confirm the provider accepts Medicaid as a form of payment.  Get help here.


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