Page Reviewed / Updated - Mar. 2016
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 supports include coverage for home modifications to increase the resident's safety and access, personal emergency response services to reduce supervision and transportation assistance to get to medical appointments and for other errands.
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 become paid caregivers under COPES. Medicaid sets the caregiver's wage, not the family. This rate ranges from approximately $11 to $15 per hour.
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 2016 of $ 2,199 / month. There is a countable asset limit in 2016 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 unusually 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 is $119,220 plus $2,000 in 2016. Lawmakers developed the Community Spouse Resource Allowance—as this limit is known—to allow the healthier spouse to continue to afford to live independently.
Washington state residents who 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.
Individuals approved for the COPES Waivers can receive any of the following services. Case-by-case approval may be required.
*These services were only be available until July 1, 2015. They have been moved to Washington's Community First Choice (CFC) Program.
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 and find more information online at the following webpage.