Washington-specific Medicaid spend-down rules
Washington administers Apple Health through the Health Care Authority (HCA) and the Department of Social and Health Services (DSHS). Long-term care applications for people age 65 and older usually start at a local Community Services Office or through Washington Connection in counties like King, Pierce, and Spokane.
Classic Medicaid covers nursing facility care. The COPES waiver pays for personal care at home, in adult family homes, and in assisted living when someone would otherwise need a nursing home. Asset tests still follow the same $2,000 resource standard for the applicant in both paths.
Washington allows certain medically necessary expenses incurred before eligibility to reduce countable resources on the application. Nursing facility bills are reduced at the state rate for the facility that provided care. COPES projected service costs cannot be used the same way.
Community spouses may keep the greater of the CSRA calculation or certain income protections under spousal impoverishment rules. Washington uses a home equity cap of $1,130,000 in 2026 unless a spouse or dependent child still lives in the house.
Burial spaces, one vehicle, and up to $1,500 in a designated burial fund can be excluded if titled correctly. Prepaid funeral contracts follow separate HCA policy memos.
Look-back reviews cover asset transfers made within 60 months before application. Penalty length equals the uncompensated transfer amount divided by the private nursing facility daily rate published by HCA.
Families in Bellevue and Everett follow the same resource test as applicants in Olympia and Bellingham. COPES interest lists vary by region, but the $2,000 asset cap does not.
Common mistake: Assuming Washington exempts a second home because it is "in the family." Non-homestead real estate counts unless occupied by a spouse or dependent child under HCA rules. Budget property taxes and sale costs before you rely on an appraisal.