Medicaid is a government health insurance program available to people with very limited income and resources. Medicaid does not pay money to you. It sends payments directly to your health care providers. Medicaid can pay for medical services in your own home or if you live in a residential care facility that takes Medicaid residents.
Medicaid and Adult Family Homes
Adult Family Homes are regular neighborhood homes where staff assumes responsibility for the safety and well-being of the adult. A room, meals, laundry, supervision and varying levels of assistance with care are provided. Some provide occasional nursing care. Some offer specialized care for people with mental health issues, developmental disabilities or dementia. The home can have two to eight residents and is licensed by the state.
Medicaid will pay for care only when someone becomes financially eligible. There are many Adult Family Homes (AFH's) in Washington State that accept Medicaid. There are some AFH's that will accept a resident upon admission that has Medicaid as a form of payment but these homes may be full as the need is high. The majority of AFH's will require a new resident to pay privately for a set amount of time before transitioning the resident to medicaid. This is referred to as medicaid spend down. The time required for private pay can range from 6 months to 3+ years or until all the residents' funds are exhausted and the resident becomes "financially eligible" for medicaid.
What sets an Adult Family Home apart from Assisted Living is that AFH offer a transition to medicaid. Many Assisted Livings do not accept medicaid as a form of payment. It is very beneficial for a Senior to enter an Adult Family Home knowing that they will stay in the same place even when their hard earned funds are used up. Washington State has set guidelines for all Long Term Facilities that accept medicaid to follow. Refer to WAC 388-76-10522.
The adult family home must fully disclose the home's policy on accepting Medicaid payments. The policy must:
To explore an adult family home as an option, find out what kinds of services and supports are available at each home you are interested in. For more information about the types of questions to ask and things to look for when finding an adult family home
If you are 18 or older, you can apply for Medicaid through your local Home and Community Services (HCS) office or online.
There are three main parts to the application process:
1. Filling out and turning in an application.
2. A financial review to determine your financial eligibility.
3. A personal care needs assessment to determine your functional eligibility.
Call or visit your local HCS office to get a Washington Apple Health Application for Long-Term Care/Aged, Blind, Disabled Coverage (18-005).
This form can also be downloaded from the Health Care Authority website
To apply online for cash, basic food benefits and long-term care, you may go to Washington Connections .
All Washington residents can apply for Health Care Coverage including institutional Medicaid through the wahealthplanfinder.org
For long-term care services you may apply online through the health plan finder. Indicate you are applying for long term care services.
The Statewide Health Insurance Benefits Advisors (SHIBA) HelpLine provides free help to people of all ages with questions about health insurance, health care access, and prescription access. Contact the SHIBA HelpLine .
Information you will need to provide includes:
There are many different types of homes or facilities where a person can live and get care services in a residential setting. One important consideration is whether the person will be using state funds (Medicaid) to pay for care. If state funds will be used, the home or facility must be licensed by Washington State and accept Medicaid payment for residents.
Long-term residential care options include: