Washington Medicaid (Apple Health) 2026: LTC & $1.13M Equity

Washington Apple Health covers long-term care with a $2,000 asset limit, no Miller Trust, a medically needy spend-down pathway, and a $1,130,000 home equity limit (the federal maximum).

Washington Medicaid, known as Apple Health, is administered by the Washington State Health Care Authority (HCA), with long-term care eligibility processed by the Department of Social and Health Services (DSHS) Home and Community Services. Washington does not require a Miller Trust: an applicant with income above the $2,982-per-month special income level qualifies through the medically needy spend-down instead. The state also elects the federal maximum home equity exemption, $1,130,000 for 2026. This guide maps every key question about Apple Health long-term care to the dedicated article that answers it.1

What Washington Apple Health Covers

Washington Apple Health covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: Inpatient and outpatient
• Physician, clinic, and specialist visits
• Prescription drugs through the Apple Health pharmacy benefit
• Behavioral health: Mental health and substance use disorder services
• Home health: Skilled nursing and home health aide services
• Long-term care: Nursing facility care and home and community-based services (HCBS) waivers for people who meet the clinical level-of-care standard
• Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries
• Non-emergency medical transportation (NEMT)

For older adults, long-term care is the most financially significant benefit. In Washington, a semi-private nursing home room runs a median of about $157,859 per year and a private room about $191,625, according to the CareScout 2025 Cost of Care Survey, well above the national median. Apple Health covers that cost once a resident is financially and clinically eligible.2

Who Qualifies for Washington Apple Health

Washington Medicaid Eligibility Overview

For seniors and people with disabilities seeking long-term care coverage, Washington uses a special income level for nursing facility and HCBS waiver eligibility. The key 2026 financial parameters, per WAC 182-513-1350:1

• Asset limit: $2,000 for a single applicant; $3,000 for a married couple. Countable assets exclude the primary home (subject to the equity cap), one vehicle, household goods, and prepaid burial.
• Special income level: $2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate of $994. Applicants at or below this level qualify for nursing facility coverage directly.
• No Miller Trust required: An applicant with income above $2,982/month does not need a Qualified Income Trust. Washington instead uses the medically needy pathway (medically needy income level of $994/month for a single person), letting the applicant qualify by incurring medical and care costs that bring net income to or below that standard.
• Home equity limit: $1,130,000 for 2026. Washington elects the federal maximum home-equity exemption, tied to the CMS-posted annual figure. This is well above the $752,000 minimum that applies unless a state elects higher.3

For full income limits, asset rules, and the spend-down calculation, see Washington Medicaid Eligibility & Income Limits.

Washington Medicaid Long-Term Care

Nursing Facility Coverage

Washington Apple Health covers nursing facility care for eligible older adults who meet the clinical level-of-care standard. Once eligible, Medicaid pays the cost of care. The resident contributes most monthly income toward the facility's cost, keeping a Personal Needs Allowance of $108.74/month, plus deductions for a community spouse and certain health insurance premiums.1

HCBS Waivers

DSHS administers home and community-based services waivers, including the COPES waiver and Community First Choice, that fund personal care, homemaker services, adult day care, and other supports for people who would otherwise require nursing facility care. Waiver eligibility uses the same asset standard and income rules as nursing facility Medicaid. Because waiver slots are capped, some services carry a waitlist, so families should apply as early as possible rather than waiting until care is urgent.

The 5-Year Lookback

Washington applies a 60-month lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window create a penalty period of Medicaid ineligibility for long-term care services.3

Estate Recovery

After the death of a recipient age 55 or older, Washington pursues federally mandated estate recovery. For dates of service on or after January 1, 2014, the services subject to recovery are long-term care and state-only-funded services (nursing facility care, hospice, Medicaid personal care, COPES and other HCBS waiver services, private duty nursing, and the hospital and prescription-drug services received while getting that care). Washington applies the recovery law as it stood on the date the benefits were received, so services received between January 1, 2010 and December 31, 2013 remain recoverable whether or not they were long-term care. Importantly, Washington is an expanded estate-recovery state, not probate-only: under RCW 43.20B.080 the state recovers from the probate estate and from nonprobate assets defined by RCW 11.02.005. Jointly held real estate, payable-on-death and transfer-on-death accounts, community property agreements, life estates, and living trusts can all be reached. Recovery is deferred while a surviving spouse, or a surviving child who is under 21 or blind or disabled, is living, and Washington's undue-hardship process under WAC 182-527-2750 delays recovery rather than cancelling it, in narrowly defined situations.3

See Washington Medicaid Estate Recovery for the full rules, exemptions, and hardship process.

Washington Medicare Savings Programs

Washington administers Medicare Savings Programs (MSPs) through Apple Health for low-income Medicare beneficiaries. Washington applies no asset test to its MSPs and uses broader income limits than the federal baseline:4

QMB enrollees are automatically deemed eligible for Part D Extra Help, and federal law bars providers from billing a QMB enrollee for any Medicare cost-sharing. Apply through Washington Connection or with free help from a local SHIBA counselor.4

See Washington Medicare Savings Programs for full details.

Spousal Impoverishment Protections

When one spouse enters a nursing facility and the other remains at home, Washington applies federal spousal impoverishment protections so the community spouse is not left without resources.5

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): The community spouse keeps at least $32,532 and up to $162,660 in countable assets, based on a snapshot of the couple's combined assets at the time of application.5
• Minimum Monthly Maintenance Needs Allowance (MMMNA): Up to $4,066.50/month in income (effective January 1, 2026), with a floor of $2,705.00.5
• Home: Exempt while either spouse lives there, subject to the $1,130,000 equity limit.

Washington's high home equity limit means the home rarely blocks eligibility here, even for families whose equity would exceed the federal minimum. It does not protect the home after death: Washington's expanded estate recovery reaches jointly held real estate, transfer-on-death deeds, life estates, and living trusts, so a home passing outside probate can still be pursued.3 See Washington Spousal Impoverishment Protections for how the snapshot process and income allocation work.

How to Apply for Washington Apple Health

Applying for Washington long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the DSHS pathways.

See How to Apply for Washington Medicaid for the full step-by-step process and required documents.

If Washington Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road. Two clocks start when the notice arrives, and the one that keeps your coverage running is far shorter than the one to file.

Washington's deadline is 90 days, counted from the date at the top of the notice, not from the day it reached you. You have 90 days from the date printed at the top of the notice the Health Care Authority (HCA) mailed you to request an administrative hearing, and if you do not request one within 90 days you may lose the right to a hearing altogether.6

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.7 The 90 days is 42 CFR 431.221(d)'s ceiling on what a state may allow, not a floor you are entitled to, and a state is free to set a shorter window that binds you.8 Washington happens to allow the full federal maximum, so here the ceiling and the deadline are the same number. Even so, read the date off your own notice.

There is a second, far earlier deadline that matters more if you are already enrolled. If HCA ended or reduced coverage you already have, you can keep it running through the hearing only if you ask for the hearing within 10 days of receiving the notice or by the end of the month, whichever is later.6 That is Washington's version of the federal rule that requesting a hearing before the date the action takes effect keeps benefits in place.9 Continued coverage is not available to fight the denial of a new application, and if you keep coverage and then lose the hearing you may have to pay back up to 60 days of it.6

When an adverse notice arrives, find that 10-day date and request the hearing in writing before it. One route is different: if an Apple Health managed care plan denied the service, you must exhaust that plan's own appeal process before you can request an administrative hearing, which is a separate track from the eligibility-denial deadline above.6 See Washington Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping Washington Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Before it can ask you for anything, Washington Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.10 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, Washington may offer the same windows but is not required to, so ask DSHS what applies to you.10

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).10

Keep your address current, open anything from Washington Medicaid, and return a renewal form the week it arrives. See Washington Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

Washington Medicaid FAQ

Learn More

Find personalized help with Washington Apple Health and long-term care at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.