Washington COPES Medicaid Waivers Program
- The Washington COPES Medicaid Waivers Program covers personal care services for those who need nursing home care but want to live at home or in assisted living.
Nursing home care is expensive, and while Medicare may help cover some services, older adults may spend a significant portion of their retirement income to fill in the coverage gaps. The Washington COPES Medicaid Waiver Program covers services to help seniors get the skilled nursing services they need in their own homes or a residential community setting.
What Does Washington COPES Medicaid Waiver Program Cover?
COPES covers a wide range of services to help older adults age in place, even as their care needs change. Benefits are customized to the individual to help them avoid nursing home placement. COPES may also provide care coordination and transition services for those who currently live in a nursing home but want to move to a non-institutional setting such as their own home, the home of a friend or family member or an assisted living facility.
Benefits under COPES may include:
- Adult day health care
- Wellness education
- Community choice guiding (identifying and obtaining services in the community)
- Community supports (covers one-time fees, such as utility deposits and home modifications, for those transitioning out of nursing homes into the community)
- Durable medical equipment
- Home modifications
- Skilled nursing services
- Nursing services
- Medical and non-medical transportation
Who Is Eligible for COPES?
To be eligible for this program, applicants must be at risk of nursing home placement and at least 65 years old or between the ages of 18 and 64 and blind or disabled. Applicants must be U.S. citizens or legal residents and permanent residents of Washington.
Individuals must meet Medicaid’s financial criteria for income and assets. The income limit is 300% of the Federal Benefit Rate, which is reevaluated annually. In 2021, applicants can have a monthly income of no more than $2,382, and there’s an asset limit of $2,000. Not all assets are counted toward this limit, including the applicant’s primary dwelling, household appliances and furnishings, personal belongings and one vehicle.
In cases where the applicant is married and their spouse isn’t applying for COPES, there are provisions to ensure their financial stability. The non-applicant spouse’s income doesn’t count toward the income limit. Additionally, income from the applicant can be transferred to the non-applicant. This monthly maintenance needs allowance can be up to $3,260. If the non-applicant has their own income that’s at least this amount, they’re not entitled to the maintenance needs allowance. While both spouses have to meet asset limits if one spouse is applying for COPES, the allowance for the non-applicant is much higher at $130,380.
The applicant must also require nursing-home-level care to qualify for COPES. Washington uses the Comprehensive Assessment Reporting Evaluation tool to assess whether the individual is eligible. Applicants must need daily nursing care, or they must be completely dependent on assistance for two daily living activities or need some help with at least three.
It’s important to note that COPES isn’t an entitlement, meaning that it has limited funding and it caps enrollment at 47,000 spots. Even if an individual meets the program’s eligibility criteria, they may be placed on a wait-list until a spot opens up. Their place on their wait-lists depends on when they applied and their levels of need.
Qualifying When Over the Limits
Even if the individual’s income and assets exceed COPES’ limit, they may have options for qualifying for services.
Those whose income is too high may qualify for services under the Medically Needy Medicaid Program. This spend-down program lets applicants spend their excess income on medical expenses and health insurance premiums, such as Medicare’s monthly premiums. Once the individual has $2,382 left in monthly income, COPES covers the remaining care expenses.
While those whose assets exceed Medicaid’s limit may consider selling or gifting excess assets to meet this criterion, this can result in disqualification. Medicaid has a five-year look-back period. If an individual transferred assets within five years before applying for COPES and their assets would have put them over the limit, they may be denied coverage.
For those whose assets exceed Medicaid’s limits, irrevocable funeral trusts may be an option. These trusts are prepaid funeral and burial expense trusts that Medicaid doesn’t count toward the asset limit. Alternately, assets may be used to purchase an annuity, which provides a steady stream of income.
Enrolling in COPES
The Washington COPES Medicaid Waivers Program is available in all of Washington’s 39 counties. To apply for services, individuals can visit their local Home and Community Services office, or they can apply online here. Generally, it takes 45-90 days for the Medicaid agency to review the application and accept or deny the request. Missing documentation or incorrectly filled applications may slow the process.