Washington Medicaid COPES Waiver: Eligibility and Benefits

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

Thousands of Washington state seniors benefit from the Community Options Program Entry System. 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 alternative care environment, such as an assisted living residence. This program provides not only care, but also other supports to enable a successful transition to 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.

 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. The senior’s adult children may become eligible to provide personal care. Spouses, however, are ineligible to become paid caregivers under COPES. Medicaid sets the caregiver's wage, not the family. This rate ranges from approximately $12 to $15 per hour.

 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 couple’s or individual’s income, bank accounts, investments, and properties. 

Washington Apple Health Medicaid waivers have an individual income limit in 2017 of $ 2,205 / month. Separately, there is a countable asset limit in 2017 of $2,000. Eligible applicants can have not more than $2,000 in all their bank and retirement accounts. 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 $120,900 plus $2,000 for the applicant. 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.

As of July 1, 2015, Washington state residents who need long term care at home have another option: Community First Choice Option.


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 were only be available until July 1, 2015. They have been 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 and 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.