Community Options Program Entry System Waiver (COPES)

The COPES program pays for long-term care in your home or in a community setting, like assisted living or an adult family home. COPES care can include help from a trained caregiver to shower, dress, eat, use the toilet, walk, change position in bed, and manage your medications.

You can apply online through the DSHS website at washingtonconnection.org/home or go to your local DSHS office. Use the office locator at dshs.wa.gov/office-locations to find an office near you. You can ask DSHS for help applying for the program. Read DSHS Help for People with Disabilities: Necessary Supplemental Accommodations to learn more.

You are eligible for COPES if your income is $13,542/month or less.

Once you start getting COPES, you may have to pay some of your income for your care. For instance, if you are single and live at home, you can keep up to $2,901/month of your income. You will pay anything over that amount for your care.

Also, if you are married, your spouse's income won't be counted to decide if you are eligible for COPES, but their income might affect how much you pay for your care once you are getting COPES.

We explain how much you have to pay for your care, if anything, below.

The resource limit is $2,000 for you.

If you are married, the resource limit for your spouse is $68,301 if you live at home and $157,920 if you live in a hospital or nursing home.

Some resources, like your house, car, and personal items don't get counted for the resource limit. Read What can I buy and still be eligible for SSI and/or Medicaid? to learn more.

Once DSHS decides you're financially eligible for COPES, a case manager will interview you to find out what kind of help you need – it's called a CARE Assessment.

Coverage starts when DSHS approves your COPES application. There is no retroactive coverage for COPES.

Yes. All COPES recipients get Medicaid coverage for other medical expenses like physician services, prescription drug, and home health services.

Yes. If you're eligible for COPES, you're also eligible for the Qualified Medicare Beneficiary (QMB) program, which pays your Medicare premiums, co-payments, and deductibles. You can find out more about QMB and other Medicare Savings Programs on WashingtonLawHelp.org.

Maybe. It depends on your income and whether your spouse gets COPES too.

• If you're single and you live at home, you can keep $2,901/month.  You must pay any income left over for your care.

• If you're married, your spouse is also on COPES, and you both live at home, you can each keep up to $2,901/month. You must pay any income left over for your care.

• If you're married, but your spouse is not on COPES, you can keep up to $967/month. You must pay any income left over for your care.

Probably. If you live in a residential community, like a nursing home, assisted living or adult family home, you can keep a "personal needs allowance" (PNA) of $105.78/month. The rest of your income will go to pay for your care, room, and board.

Some of your income can be set aside for special purposes, including guardian or conservator fees, child support, medical expenses, dependent family member care, and an allowance for your spouse if you are married.

If you live at home, your PNA will be higher.

Maybe. If your spouse does not get COPES, they can keep all the income paid in their name. They can also keep as much of your income needed to get up to $3,948/month which is the "Community Spouse Maintenance Needs Allowance" maximum.

Maybe. If your spouse does not get COPES, they can keep all the income paid in their name. Most of your income will go to pay for your care, food, and housing. There may not be any of your income left for your spouse to keep. But if your spouse's housing costs are high, talk to your DSHS worker about letting your spouse keep more of your income.

Maybe. There is no penalty when you transfer your home to:

• Your spouse.

• Your disabled child.

• Your sibling who has an equity interest in the home and lived there at least 1 year before you got COPES.

• Your child who lived in the home and cared for you at least 2 years before you got COPES. (Your child must provide proof that they provided care.)

Maybe. But be careful! If you give away resources during the 5 years before you apply for COPES or while you're getting COPES, you might not get COPES, or your COPES might stop for a period ("penalty period").

There is no penalty when:

• You sell a resource for fair market value.

• You give away an exempt resource other than your home.

• You give a gift(s) of $422 or less in any calendar month.

If you give something away for less than fair market value, DSHS will divide the value of the gift by the Daily Private Nursing Facility Rate to determine the number of days in your penalty period.

For example, if you own a home with $50,000 equity and you give it to your adult child who is not disabled and hasn't been your live-in caregiver for over 2 years, you won't be eligible for COPES for 118 days ($50,000 ÷ $422).

Maybe. DSHS might try to get money from your estate after you die, including putting a lien on your home if you owned it when you died. The program is called Estate Recovery. Read Estate recovery for long-term care services paid for by the State to learn more.