01. Overview & references
Washington uses Apple Health for Medicaid, but long-term services and supports require more than ordinary health coverage. Home and Community Services reviews financial eligibility while a CARE assessment establishes care needs. A nursing-facility application and a COPES request can therefore follow related financial rules without producing the same service package. The special income level in the table identifies one eligibility route. It does not establish an automatic approval or rejection. Start by identifying the requested setting, whether a spouse remains at home, and which agency is assessing the person who needs care.
- State Medicaid program
- Washington Apple Health
- Income pathway
- Program-specific financial rules
- Nursing-home look-back reference
- 60 months
- Home-equity reference
- $1,130,000
- Personal-needs allowance reference
- $108.74
- Reviewed
- 2026-11-16
Read the program row before using any number. A nursing-facility pathway, a particular home-care waiver and regular coverage for older or disabled adults can use different financial tests. A published financial standard does not establish the required level of care, reserve a waiver place or pay every assisted-living expense. Confirm the exact category with the agency.
02. Income & asset table
A countable-income standard is not the same as a gross-income ceiling. Deductions, disregards and ownership rules may affect what the agency counts. For a married applicant, ask whose income is being evaluated and whether the resource figure is individual or combined. Where the available source does not support one comparable number, this guide leaves it unspecified instead of estimating it.
| Care category | Income references | Countable-asset references | CSRA maximum reference |
|---|---|---|---|
| Apple Health nursing-facility LTSSThe published PNA is the all-other-medical-institutions figure; cash assistance and certain veterans’ settings differ. | Single: $2,982Special Income Level for an institutional pathway. Other medically needy rules can apply above it.Married, one applies: $2,982Special Income Level for an institutional pathway. Other medically needy rules can apply above it. This is the applicant’s reference, not combined marital income.Married, both apply: Program-specific; see notesNo verified combined-couple threshold is published here; each spouse needs a separate eligibility review. | Single: $2,000Countable resources after exclusions.Married, one applies: $2,000Applicant-side resources after the spousal assessment; not a ceiling on all marital property.Married, both apply: Program-specific; see notesDo not double the single-person limit or apply a community-spouse allowance when both receive institutional care. | $162,660Community spouse only; program applicability and allocation must be assessed. |
| COPES/HCS home and community-based waiversAssessment and an approved service plan are separate from income eligibility. | Single: $2,982SIL reference, not an absolute COPES income ceiling; WAC182-515-1508 includes an above-SIL route.Married, one applies: $2,982SIL reference, not an absolute COPES income ceiling; WAC182-515-1508 includes an above-SIL route. This is the applicant’s reference, not combined marital income.Married, both apply: Program-specific; see notesNo verified combined-couple threshold is published here; each spouse needs a separate eligibility review. | Single: $2,000Countable resources after exclusions.Married, one applies: $2,000Applicant-side resources after the spousal assessment; not a ceiling on all marital property.Married, both apply: Program-specific; see notesDo not double the single-person limit or apply a community-spouse allowance when both receive institutional care. | $162,660Community spouse only; program applicability and allocation must be assessed. |
| SSI-related Apple Health: category review neededThe resource figures are the verified SSI-related medically-needy references; another coverage category may differ. | Single: Program-specific; see notesA complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table.Married, one applies: Program-specific; see notesCouple/household reference where spouses are included together; exclusions and deeming require agency review. A complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table.Married, both apply: Program-specific; see notesCombined couple countable-income reference, not a gross-income ceiling. A complete 2026 categorically-needy income row was not verified; no gross limit is inferred from the medically-needy table. | Single: $2,000Individual countable resources.Married, one applies: Program-specific; see notesThe couple resource reference is 3,000 dollars combined, not an applicant-only allowance.Married, both apply: $3,000Combined countable resources for the two-person assistance unit. | Not inferred for regular coverageCommunity spouse only; program applicability and allocation must be assessed. |
03. Countable & excluded assets
Countable resources are different from everything a person owns. A home, vehicle or other property can receive an exclusion when the applicable conditions are met. Washington separately publishes a long-term-care home-equity standard, so an excluded home still needs an equity review where that rule applies. Explain who owns the property, any mortgage balance and who lives there. A spouse or qualifying child can change the analysis. Selling an excluded item may change its treatment once the proceeds become cash; request a case-specific explanation before acting.
Keep the ownership question separate from the exclusion question. A bank balance or property value alone does not establish what the agency counts. Document ownership, debt, accessibility and the reason for any proposed exclusion. Do not assume that renaming an account or transferring an asset makes it exempt.
| Often considered countable | Potential exclusions — verify conditions |
|---|---|
| Bank deposits, accessible investments, securities and other real estate may require valuation. | A principal home, a vehicle, personal effects and certain burial or life-insurance arrangements may qualify under specific rules. |
04. Community-spouse protections
Washington publishes both a state spousal resource standard and a federal spousal maximum. They should not be collapsed into a promise that every community spouse can keep the maximum. The setting and the applicable spousal assessment matter. Likewise, income allowances for a married waiver participant differ from those for some single participants. Bring both spouses’ financial information, even if only one requests services, and ask for separate written figures for applicant resources, the community spouse’s protected share, and any income allocation.
A community-spouse allowance is an assessment rule, not a cash payment or an automatic entitlement to the displayed maximum. The income allowance and resource allowance are separate calculations. Federal benchmarks can help identify which questions to ask, but they do not replace the applicable state worksheet or an individual determination.
Federal benchmarks, not automatic state allowances
Minimum MMMNA effective July 1, 2026; maximum and resource standards January 1, 2026. All 20 states in this directory are in the contiguous United States.
CMS standards and effective dates05. Higher income, transfers & recovery
Being above the special income level deserves a second review. For HCS waivers, Washington’s rule allows an alternative calculation involving available income, permitted disregards, the average state nursing-facility rate and specified medical expenses. Institutional medically needy rules are another distinct calculation. A web comparison cannot reproduce these assessments using a pension total alone. Ask the public benefits specialist which category was evaluated and request the income worksheet. Cost participation after approval is a separate question: qualifying does not necessarily mean retaining every dollar of income.
The DSHS adult LTSS brochure describes a 60-month review of transfers for institutional and home-and-community-based waiver applications. A gift or sale below fair market value may affect payment for LTSS, but the review must examine the transaction and any applicable exception. Keep evidence of dates, ownership, consideration received and the purpose of unusual transactions. The lookback period is not a universal instruction that every applicant must immediately upload five years of every document. Follow the specialist’s actual verification request and keep copies of what you submit.
Estate recovery and eligibility are different decisions. Washington’s 2026 brochure describes recovery of specified federally funded LTSS received after age 55 and certain state-funded benefits under different age rules. A home excluded during eligibility can still be relevant to a later estate claim. Surviving-spouse and qualifying-child protections, tribal exclusions and other exceptions must be considered. The application also discusses limited circumstances involving liens during permanent institutionalization. Ask for the current recovery brochure rather than assuming either that every medical visit is recoverable or that home ownership is always protected.
Review transfer history before making financial changes. The look-back interval, a potential penalty period, treatment of the home and estate recovery are different issues. Exemptions, protected relatives and hardship procedures can matter. Ask the agency which rule applies to the service and application date; seek qualified advice before signing an agreement or moving property.
06. Document checklist
Use the aged, blind, disabled/long-term-care application or the official benefits route identified by DSHS, and tell the office that long-term care is requested. Organize benefit award letters, bank ownership and balances, insurance premiums, property details and unpaid medical bills. Record the requested service setting and the contact handling the CARE assessment. If information is missing, ask what alternative verification is accepted and how to preserve the application date. Keep the eligibility notice and cost-participation notice together; they answer different financial questions.
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07. Frequently asked questions
Is COPES limited to the special income level?
No. WAC182-515-1508 includes an alternative above-SIL calculation. The HCS specialist must evaluate the allowed deductions and current state nursing-facility rate.
Is WA Cares the same as Apple Health?
No. This guide covers Medicaid financial eligibility. Do not apply these resource and income references to a different long-term-care insurance program.
Is the institutional PNA my eligibility limit?
No. A personal needs allowance affects income retained after eligibility. Washington publishes different allowances for medical institutions, cash-assistance recipients and community settings.
Why is regular Apple Health income blank here?
The complete current categorically-needy row was not confirmed during this review. A blank avoids presenting a medically-needy or federal reference as the wrong state threshold.
Source register
- Apple Health income and resource standards, January 2026Consulted: 2026-11-16 · Official search excerpt used; direct-page verification limited.
- WAC182-515-1508 HCS waiver financial eligibilityConsulted: 2026-11-16 · Official source
- Apple Health and LTSS for adults, DSHS22-619Consulted: 2026-11-16 · Official search excerpt used; direct-page verification limited.
- Estate Recovery, DSHS14-454, March 2026Consulted: 2026-11-16 · Official search excerpt used; direct-page verification limited.
- Application for ABD/long-term-care coverageConsulted: 2026-11-16 · Official search excerpt used; direct-page verification limited.
- WAC chapter 182-513 institutional medical rulesConsulted: 2026-11-16 · Official search excerpt used; direct-page verification limited.