What do you get with Washington state’s new $36,500 lifetime long-term care benefit?
That could include about 2,281 home-delivered meals, an 80-day stay in an adult residential facility, transportation services for seven years or $15,000 worth of assistive devices and technology to help with disabilities, according to a state working group.
Long Term Services and Support Trust BoardThe group, made up of lawmakers, representatives from state government agencies, long-term care workers and beneficiaries, is in the process of finalising the fees the WA Cares Fund will pay for certain services.
To fund the program, the state levies a 0.58% tax on most Washington workers’ paychecks, and starting in July 2026, eligible people will be able to access the funds to cover the costs of care, equipment, medicines and more.
Initiatives on the November ballotIf passed, the bill would change the system to allow workers to opt out of paying taxes and receiving benefits at any time. If too many workers don’t want to participate, it could have huge financial consequences and ultimately make the system unsustainable.
In this program, the maximum benefit is Eligible Resident The maximum amount you can receive is $36,500. The state plans to gradually adjust this amount for inflation.
The commission voted on its final recommendations at its Wednesday meeting on how the stipend could be used for equipment, home-delivered meals, personal emergency response systems and home improvements. The commission unanimously approved those proposed fees.
Commissioners also discussed fee recommendations for other services, including adult day care, transportation, family caregiver leave and in-home care. Those recommendations will be voted on at an upcoming committee meeting and then sent to the Department of Social and Health Services, where rates will be finalized in the rulemaking process.
“This wasn’t an easy conclusion to reach,” said Commissioner Mark Stensger, who led the rate-setting working group. “This is a complex issue and we’ve taken into consideration what it would be like for consumers to think about how they would use their benefits.”
The group looked at both Medicaid rates and private rates analyzed by risk management firm Milliman, which did actuarial analysis on the program.
Stensensager said he decided to use private rates rather than Medicaid rates to give people as much flexibility as possible in using their benefits and to allow them to choose lower- or higher-cost providers.
There are some exceptions to the rates, and the Commission authorizes the Department of Social and Health Services to grant benefits above the maximum rate in certain circumstances. Some rates may also vary by geographic location.
Fee
For relatively inexpensive services like meal delivery, equipment upgrades and daily transportation, WA Cares will cover most of what you need.
The benefits could pay up to $16 per delivered meal, $400 a month in transportation reimbursement and $15,000 for equipment such as wheelchairs and technology such as screen readers and Braille devices.
To give family caregivers a break, the benefit could also provide up to $45 per hour for in-home caregivers or up to $325 per day for adult day care to give family caregivers a break.
But for more expensive services such as senior family homes and assisted living facilities, the benefits may not be as great.
The fund will pay up to $455 a day for adult family homes, $540 a day for assisted living facilities and $535 a day for nursing homes. Facilities can’t charge the maximum amounts unless they can justify the costs in resident evaluations, according to the commission.
The cost of a private room in a nursing home in Washington state was $450 a day on average in 2023. It is estimated that From Genworth, a private long-term care insurance company.
The state is encouraging Washington public benefit recipients to combine it with other payment methods, and Stensaeger said recipients should be strategic about how they use public benefits to pay for more expensive services.
“If people want to combine private payments with WA Cares they can do that but the amount they pay cannot exceed the maximum amount,” Andrea Mewes-Sanchez, WA Cares policy and planning officer at the Department of Social and Health Services, said. “We don’t want people to get surprise bills.”
Please see below for more details on the proposed fees. WA Cares website.
