Medicaid

Find an Adult Family Home in Washington State

Medicaid

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.

WAC 388-76-10522

Resident rights-Notice-Policy on accepting Medicaid as a payment source.

The adult family home must fully disclose the home's policy on accepting Medicaid payments. The policy must:

  1. Clearly state the circumstances under which the adult family home provides care for Medicaid eligible residents and for residents who become eligible for Medicaid after admission;
  2. Be provided both orally and in writing in a language that the resident understands;
  3. Be provided to prospective residents, before they are admitted to the home;
  4. Be provided to any current residents who were admitted before this requirement took effect or who did not receive copies prior to admission;
  5. Be written on a page that is separate from other documents and be written in a type font that is at least fourteen point; and
  6. Be signed and dated by the resident and be kept in the resident record after signature.

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, see our brochure: Choosing Care in an Adult Family Home or Assisted Living Facility.

How to Apply for Medicaid

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.

Apply in person or by mail

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

  • Washington Apple Health Application for Long-term Care/Aged, Blind, Disabled Coverage Form (Form 18-005)

Apply on-line

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

Information you will need to provide includes:

  • A Social Security number.
  • Proof of identification.
  • Proof of income.
  • Documentation of resources (such as bank statements, property tax statements, life insurance)
  • Immigration or alien documents.
  • Proof of citizenship if you do not receive Medicare or Supplemental Security Income (SSI)
  • Manual material on long-term care application processes .

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:

State licensed:

  • Nursing Homes
  • Adult Family Homes
  • Assisted Living Facilities

Information Obtained From:

https://www.dshs.wa.gov/altsa/home-and-community-services/how-apply-medicaid

Contact Our Free Senior Placement Specialist