Page Reviewed / Updated - March 30, 2020
Washington State's Nurse Delegation Program is a unique Medicaid program that can help lower the cost of home care, adult family care, or assisted living. It can also 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 insulin injections. Previously, persons 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. (The caregiver must be licensed with the state as a nursing assistant.) Once competent at handling this task, daily visits from a nurse or extended stays at a nursing home are no longer required, thereby significantly reducing one’s 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.
Medicaid, also called Apple Health, in Washington State is intended for individuals with limited financial means. Applicants are evaluated based on their monthly income, medical expenses, countable assets, and sometimes, on past asset transfers.
Income - Categorically Needy (CN) applicants can qualify based on their income. In this case, as of 2020, individuals should have monthly income no greater than $783. Aged (65+) applicants can qualify under the Special Income Rule. This rule sets the limit at $2,349 (in 2020) 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 $783 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. Furthermore, the applicant spouse is able to transfer as much as $3,216 / month to his / her non-applicant spouse to ensure the non-applicant spouse has sufficient means from which to live. This is called a monthly maintenance needs allowance.
Assets - individuals are limited to $2,000 in countable assets (resources). A home, primary vehicle, irrevocable funeral trust, and some other personal effects are considered exempt when determining the total value of one's assets. However, for the home to be exempt, the program participant or their spouse must live in the home. In addition, the equity value of the home cannot be greater than $595,000. Furthermore, for married couples, a non-applicant spouse, also called a community spouse, can have half of the couple’s joint assets, up to $128,640. The community spouse can keep 100% of the value of savings and retirement accounts that total to less than $58,075. This is called the Community Spouse Resource Allowance. Assets that are transferred or gifted out of the applicant's name (or even by a non-applicant spouse) in the five years preceding the application may impact eligibility. This is called the Medicaid Look-Back Period.
With this program, the state Medicaid staff will train a non-medical caregiver, including family members to perform 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 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.
To learn more about the Nurse Delegation program, click here. 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.