Long-term care and hospice

Program requirements

Long-term services and supports (LTSS)

Apple Health helps pay for care if you meet certain criteria based on your finances and a functional assessment. The care may be provided in the following settings:

• Your home
• Away from home for employment or community activity
• An alternate living facility such as a:
  • Community residential care facility
  • Assisted living facility
  • Adult family home
• A nursing facility 

LTSS programs are tailored to fit individual needs and situations. Home and Community Based (HCB) services enable people to continue living in their homes with assistance to meet their physical, medical, and social needs. Examples include the Home and Community Services (HCS) and Developmental Disabilities Administration (DDA) waivers or Community First Choice (CFC). When these needs can't be met at home, care in a residential or nursing facility is available.

Income and resource standards apply to LTSS coverage. A person must meet both financial and comprehensive functional assessment requirements to be eligible for LTSS programs. View the LTSS fact sheet. 

Tailored Support for Older Adults (TSOA) and Medicaid Alternative Care (MAC)

TSOA and MAC are programs that assist caregivers who are currently caring for a friend or family member at no cost.  Services available under these programs include:

• Respite care or home delivered meals.
• Medical equipment and supplies, such as a bath bench or incontinence supplies.
• Training and education.
• Assistance for the caregiver such as mental health counseling, or massage therapy.
• Some help for personal care needs if you do not have a caregiver (TSOA only).

The care receiver must be age 55 or older, and the caregiver must be age 18 or older.

For TSOA: Income and resource standards apply. A person must meet both financial and functional requirements to be eligible. TSOA is a program to support an unpaid caregiver, and does not offer medical coverage.

For MAC: This service is available for clients who are receiving Apple Health benefits.

Hospice

Hospice is a 24-hour intermittent program coordinated by a hospice interdisciplinary team for persons with a terminal illness and a prognosis of six months or less to live. The hospice program allows the terminally ill client to choose physical, pastoral/spiritual, psychosocial comfort, and palliative care rather than a cure. Hospitalization is used only for acute symptom management.

Hospice care is initiated by the choice of the client, or in certain circumstances, the family or physician. The client’s physician must certify a client as appropriate for hospice care. Hospice can be revoked at any time by the client, family, or hospice agency (discharge).

Hospice care may be provided in a client’s home, in a medical institution (including a hospice care center), nursing facility or in an alternate living facility.

Hospice is a covered service under most Apple Health programs; however, if you don't qualify for Apple Health through the Washington Healthplanfinder, you may be eligible for coverage under the Hospice Program, which has higher income and resources standards.

Applying for Apple Health coverage

• Online: Visit Washington Connection and click on "See If I Qualify".
• Paper application: Print and complete Form 18-005, and mail it to the Washington State Department of Social and Health Services (DSHS): DSHS Home and Community Services, P.O. Box 45826, Olympia, WA 98504-5826.
• In person: Visit a Home and Community Services office. Visit the DSHS site for office locations.

Enrollment next steps

LTSS services begin once you have been determined to meet nursing facility level of care and you have a caregiver in place to provide services. You'll receive a Services Card about two weeks after your application is processed and you're found eligible. Apple Health coverage will begin on the first day of the month in which the application was submitted if you're eligible for LTSS that month. You'll be auto-enrolled into a managed care plan, unless you have Medicare, other comprehensive insurance, or live in a nursing facility.