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 daily medical care from a registered nurse, 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 in Washington State, also called Apple Health, is intended for individuals with limited financial means. Applicants are evaluated based on their monthly income, medical expenses and countable assets.
When applying for institutional (nursing home) Medicaid, as of 2023, individuals cannot have a monthly income of greater than $2,742. 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” and are allowed to retain up to $914 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 toward eligibility. Furthermore, the applicant spouse is able to transfer up to $3,715.50 a month to his or 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.
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 $1,033,000.
Furthermore, for married couples, when only one spouse is applying, the non-applicant spouse, also called a community spouse, can retain up to $148,620 in assets. This is called the Community Spouse Resource Allowance.
Washington residents who exceed these income and asset limits but still cannot afford their care costs still might qualify for this program by working with a Medicaid planning professional. They are trained to assist applicants who find themselves in this very situation and are well versed in reallocating income and assets so that it isn’t counted toward the limits. For instance, extra income can be deposited into a Miller Trust, also referred to as a Qualified Income Trust, and an Irrevocable Funeral Trust can be used to lower one’s countable assets.
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.