Washington Medicaid COPES Waiver: Eligibility and Benefits
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
Overview of the Washington COPES Waiver
The Community Options Program Entry System, or COPES for short, is a Washington State Medicaid 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.
The waiver 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. In 2012, caregivers were paid approximately $10 / hour.
COPES Waiver Qualifications
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 Medicaid has an individual income limit in 2013 of $2,130 / month. However, the COPES program has a lower individual income limit of approximately $950 / month. There is a countable asset limit in 2013 of $2,000. This figure does not include the value of one's home or primary vehicle. In the situation where one spouse of a married couple is applying for Medicaid and the other is not, the resource limit goes up considerably to $115,920. This is called the Community Spouse Resource Allowance. There are several other types of assets that are also exempt. Burial plots, some personal jewelry and final expense trusts for example, can also be excluded when determining resources.
Washington residents that are in need of Medicaid but for a variety of reasons do not meet these limits, should consider working with a Medicaid qualification expert to help them re-structure their financial assets to meet the eligibility limits. Find assistance applying for Medicaid
Services Provided under the COPES Waiver
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
-Personal Emergency Response Services
How to Apply / Program Availability
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 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 by calling 1-800-562-3022 or find more information online at the following webpage
Use our Locator Tool to Find Other Options for which You're Eligible
Page Reviewed / Updated - Jan. 2013