Washington Medicaid Long-Term Care

Last updated: August 21, 2026 Jurisdiction: Washington

Apple Health is Washington’s Medicaid program

Washington calls its Medicaid program Apple Health. HCA’s consumer long-term-care page says Apple Health may help pay for long-term care when a person meets financial criteria and a functional assessment; it identifies Home and Community Services and Developmental Disabilities Administration waivers, Community First Choice, and nursing-facility care as parts of the long-term-services landscape (Washington HCA long-term-care overview).

The program is not administered by one office doing every task. HCA publishes Medicaid policy and financial-eligibility material, while DSHS’s CARE process is used by case managers to document functional ability, determine long-term-care eligibility, evaluate the amount of assistance, and develop a care plan (DSHS CARE overview). This division matters because a financial approval does not substitute for a functional assessment, and a functional need does not itself establish financial eligibility.

Nursing-facility care and managed care are not identical

Washington’s managed-care guidance distinguishes qualifying rehabilitative and skilled nursing-facility days, for which an Apple Health managed-care organization is responsible, from custodial long-term nursing-facility care. Once the managed-care coverage days end, ALTSA pays custodial long-term nursing-facility services fee-for-service (HCA managed-care and long-term-care guidance).

For SSI-related institutional applicants, the financial rule compares nonexcluded available income to the special income level for categorically needy coverage. The same rule separately directs SSI-related medically needy institutional clients to the medically needy LTC rules, so the SIL should not be described as the only possible income route (WAC 182-513-1317).

Start with the actual service setting

Washington’s long-term-care rules distinguish an institution, an HCB waiver, hospice, and other programs. The HCB waiver overview uses the special income level or, for certain HCS-authorized programs, a higher standard when income is above the SIL but net income is below the medically needy income level (WAC 182-513-1318).

That framework is why an accurate application discussion needs the proposed setting, current living arrangement, marital facts, income sources, resources, functional needs, and the date of any transfer. A person who needs help at home may be assessed for Community First Choice, Medicaid Personal Care, COPES, or another waiver path rather than simply being treated as a nursing-facility applicant (Washington HCA long-term-care overview).

Washington program names: Apple Health is Medicaid; HCA administers Medicaid policy; DSHS CARE documents functional eligibility; ALTSA pays custodial nursing-facility long-term care fee-for-service after qualifying managed-care days (Washington HCA long-term-care overview; HCA managed-care and long-term-care guidance; DSHS CARE overview).

Use current official material

Program operations and monetary standards can change. Ask the responsible HCA or DSHS office which program and assessment applies before making a funding decision, and use the current official standards rather than a generic national Medicaid checklist.

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Apple Health is Washington’s Medicaid program

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