Washington State Nurse Delegation Program

Waiver Description

Washington State's Nurse Delegation Program is a unique Medicaid program that can help to lower the cost of home care or assisted living and / or it can enable an individual who requires nursing care to remain living at home instead of being placed in a nursing home. 

An example is helpful to illustrate how the Nurse Delegation Program works.  An individual requires medical care from a registered nurse (RN) daily, such as assistance with tube feedings or injections. Previously, they had the choice of moving into a nursing home or paying privately for daily visits from a registered nurse. Under the Nurse Delegation Program, a registered nurse teaches the appointed non-medically trained caregiver in the proper technique(s) for managing the patient at home. Once competent at handling this task, daily visits from a nurse or an extended stay at a nursing home are no longer required, thereby significantly reducing their care costs. It is important to note that not all nursing skills can be delegated. 

At present, this program is only open to Medicaid beneficiaries.


Eligibility Guidelines

Medicaid in Washington State is intended for individuals with limited financial means.  Applicants are evaluated based on their monthly income, their medical expenses, their countable assets, and sometimes, on their past asset transfers. 

Income - Categorically Needy (CN) applicants can qualify based on their income. In this case, individuals should have less than $ 735 per month. Aged (65+) applicants can qualify under the Special Income Rule. This rule sets the limit at $2,205 (in 2017) for gross monthly income. Persons with income above this limit may still qualify if their monthly medical expenses exceed their monthly income. These persons are said to be Medically Needy (MN) and are allowed to retain up to $735 per month after their medical expenses. When the case involves a married couple with only one spouse applying, then only the income in the applicant’s name is counted towards eligibility.

Assets - individuals are limited to $2,000 in countable assets. A home, primary vehicle, irrevocable funeral trust and some other personal effects are considered exempt when determining the total value of one's assets. Furthermore, married couples can have up to $122,900 in joint assets. The community spouse can keep 100% of the value of savings and retirement accounts that total to less than $54,726. This is called the Community Spouse Resource Allowance. Assets transferred or gifted out of the applicant's name in the five years preceding the application may impact eligibility.


With this program, the state Medicaid staff will train a non-medical care giver, including family members to work some of the medically necessary activities for an individual. Thus, the primary benefit is to allow the elderly participant to return home from a nursing home and can enjoy the comfort and familiarity of their own private living quarters. If families are paying out-of-pocket for private duty nursing at home, they may be able to cut their costs if they qualify for this Medicaid program. 


How to Apply / Learn More

To apply for Medicaid in Washington, one can complete an application online or contact their local Home and Community Services (HCS) office. Married couples and persons unsure whether they meet Medicaid's requirements should strongly consider contacting a Medicaid planner prior to application. Read more.