Medicaid for nursing home care

Medicaid is a government program that pays for medical services, including nursing home care. Washington uses the term "Apple Health" to refer to Medicaid programs.  

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.

Your monthly income must be less than the "Medicaid rate" for your nursing home plus your regular medical expenses. You can ask your nursing home about their Medicaid rate.

Once you start getting Medicaid for nursing home care, you can keep $105/month for your personal needs. The rest of your income will go toward your housing, food, and care at your nursing home and other eligible expenses (for example, an amount set aside for your spouse, guardianship fees, or additional medical expenses. This isn't a complete list).

If your spouse stays at home, 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. This is the "Community Spouse Maintenance Needs Allowance" maximum.

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.

• If you're single, your resource limit is $2,000.

• If you're married, the resource limit for you and your spouse together is  $70,301 if you live at home and $159,920 if you live in a hospital or nursing home (Community Spouse Resource Limit + $2,000 for the participant).

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.

• If you're single, your resource limit is $2,000.

• If you're married, the resource limit for you and your spouse together is  $70,301 if you live at home and $159,920 if you live in a hospital or nursing home (Community Spouse Resource Limit + $2,000 for the participant).

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

• Your spouse.

• Your child with disabilities.

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

• 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 Medicaid for nursing home care or while you're getting it, you might have a "penalty period" when you're not eligible.

There's 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 or gifts up to at total of $422 or less in any calendar month. (Note: $422 is the Daily Private Nursing Facility Rate. The State sets this amount and updates it every October 1.)

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.

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.

More Information: Medicaid income and resources chart

The dollar amounts listed here are set by the federal government and Washington's Health Care Authority (HCA).

• You can find the HCA charts at hca.wa.gov/health-care-services-supports/program-standard-income-and-resources.

• You can find a simplified chart at washingtonlawhelp.org/resource/medicaid-standards.

The dollar amounts listed here are set by the federal government and Washington's Health Care Authority (HCA).

• HCA Program standard for income and resources chart

• Simplified Medicaid Standards Chart