Washington’s Medically Needy Residential Waiver

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

The Medically Needy Residential Waiver (MNRW) provides financial assistance for Washington residents to live in adult family homes, assisted living communities or Enhanced Adult Residential Care instead of in a nursing home even though they have been approved for that level of care.  This program helps the state achieve lower health care program costs while participants report higher satisfaction rates, as most individuals prefer the recreational options, social activities, and personal care they receive in assisted living or adult family care environments over skilled nursing facilities.

 Did You Know? Washington ranks in the top 5 states with the highest number of assisted living rooms per capita.  Nearby Oregon also ranks in the top 5. 


Eligibility Guidelines

Eligibility for this waiver is complicated. While it does not have strict age requirements (persons 18 and over can qualify) or geographic requirements (it is available statewide), it does have functional, financial and other requirements.

Functionally, applicants must be assessed medically and found to be in need of the level of care provided in nursing homes. However, they must choose to receive that care either in adult family homes, assisted living residences, or an Enhanced Adult Residential Care facility.

Financially, they must exceed the eligibility criteria for other WA's Medicaid programs such as Medicaid Personal Care or the COPES program. However, they must still qualify for Washington's Medically Needy Medicaid program. To do so, the state considers their care requirements and their associated costs. Then, the state looks at their monthly income to determine if they can afford their care and, if not, then they consider their financial assets as possible resources. Provided they exhaust all these resources through a process known as a “spend down,” they can qualify for the Medically Needy program. A rule of thumb is that persons with income up to about $6000 per month (provided they have sufficient qualifying medical and care expenses) and assets under $2,000 can qualify.


Benefits and Services

Depending on the location of residence, individuals approved for this waiver can receive the following services:

  • Durable medical equipment
  • Congregate meals
  • Personal care
  • Personal emergency response service
  • Skilled nursing, but not on a long term basis in a skilled nursing facility
  • Transportation assistance for medical appointments


How to Apply / Learn More

The MNRW program is available statewide across Washington. However, this is not a Medicaid entitlement program.  There are a limited number of slots available and a waiting list may exist.  Unlike many Medicaid waivers where wait lists are by county, for MNRW there is a single statewide waiting list.  Prioritization is not strictly first come, first serve but rather based on a combination of level of need, time on waiting list and current place of residence.  Those whose currently reside in a Medicaid funded nursing home will likely be prioritized.

To apply or learn more, state residents should contact their local area agency on aging. County by county contact information is available here.