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.
Thousands of Washington state seniors benefit from the Community Options Program Entry System. COPES, for short, is a Washington State Medicaid (Apple Health) waiver 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 home and community based services 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.
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.
Applicants must be at least 65 years of age or be disabled and between the ages of 18 and 64. In addition to requiring assistance with two or more Activities of Daily Living, such as bathing and getting dressed, and needing a 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 2019 of $ 2,313 / month ($12,490 / year). Separately, there is a countable asset limit in 2019 of $2,000. Eligible applicants can have no 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. For married couples with just one spouse applying for Medicaid, income of only the applicant is considered. However, in some cases, the applicant spouse is able to transfer a portion of their monthly income to their non-applicant spouse (also called a community spouse). As of 2019, up to $3,160.50 / month can be transferred to the community spouse. This is referred to as the Monthly Maintenance Needs Allowance and is intended to prevent the non-applicant spouse from having too little income in which to live. This also effectively lowers the income of the applicant spouse.
Asset limits are flexible in that many assets are not counted or are considered exempt. For example, the value of one's home, if the applicant or their spouse lives in it and the equity value is not greater than $585,000, and a 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 non-applicant spouse can have is $126,420, plus the applicant spouse can retain $2,000. Lawmakers developed the Community Spouse Resource Allowance—as this limit is known—to allow the healthier spouse to continue to afford to live independently.
Persons over the asset limit need to exercise caution when trying to meet the asset limit. Giving cash and other valuables to relatives or selling countable assets under market value can result in a period of Medicaid disqualification. This is because Medicaid has a look back period in Washington in which all past asset transfers for 5 years immediately preceding one’s application are considered.Washington state residents who are in need of assistance from Medicaid, but cannot meet the above income and asset limits should consider working with an Apple Health qualification expert. These professionals assist persons in understanding their options and helpthem to restructure their finances to meet the eligibility limits. Read more about this option here.
Benefits and Services
Individuals approved for the COPES Waiver can receive any of the following services. Case-by-case approval may be required.
Adult Day Care / Adult Day Health Care
Assisted Living / Adult Family Homes
Community Choice Guiding
Community Support: Goods and Services
Durable Medical Equipment
Environmental Accessibility Modifications to one's Home or Vehicle
Home Care / Home Health Care / Skilled Nursing
Home Delivered Meals
Personal Emergency Response Services
Non-Medical Transportation Assistance
*These services were only available until July 1, 2015 via COPES. They are now available through Washington's Community First Choice (CFC) Program. As mentioned previously, it is common for applicants to receive services via both COPES and CFC.
How to Apply / Learn More
This program is administered by the Health Care Authority and the Washington State Department of Social and Health Services, and 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 40,000, 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 needs. 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.