Washington state’s new long-term care insurance program will give residents a lifetime benefit of $36,500 to cover the costs of about 81 days in a nursing home.
The benefit is the nation’s first payroll tax plan for long-term care costs and, as such, has attracted attention from providers and the insurance industry.
The benefit can be used to pay up to $535 per day in a nursing home. The average cost of a private nursing home room in Washington state in 2023 was $450 per day, according to Genworth, a private long-term care insurance provider.
The Long-Term Services and Support Trust Board, made up of lawmakers, representatives from state agencies, long-term care workers and beneficiaries, is finalizing the amount state residents will be able to pay for services under the WA Cares program, the Washington State Standard reported.
“Funding assistance from WA Cares helps, but because of caps, facilities are still struggling to cover the costs of care for residents who require higher-cost care,” Washington Healthcare Association president and CEO Karma Mattie Jackson told McKnight’s Long-Term Care News on Friday. “Washington’s skilled nursing facilities need more financial support as the cost of providing care continues to rise. Right now, we are focused on covering the cost of care for Medicaid-insured residents with Medicaid rates so that other payers do not have to subsidize these costs.”
The commission said if service providers wanted to charge the maximum allowable amount they would need to justify the costs in resident assessments.
On July 1, 2023, the state began collecting a 0.58% tax on every $100 of most workers’ pay for this program. Eligible, eligible residents can begin taking advantage of the benefit. The benefit can be used for a variety of services to help seniors remain in their homes and transition into nursing homes. Services paid for with the benefit include medication management, activities of daily living like bathing, eating, and mobility, stays in long-term care facilities, and equipment.
The Washington State Standard reported that the program could potentially fully cover cheaper services like meal delivery and daily transportation, but “may not cover as much” stays in nursing homes or other facilities.
State officials suggest older people should combine WA Cares payments with other public benefits and people should “use benefits strategically to pay for more expensive services”.
“If people want to combine WA Cares with private payments they can do so, 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, said in an article in the Standard. “We don’t want people to be hit with surprise bills.”
Voters in Washington state will consider a ballot measure in the November election that would allow people to opt out of the tax, which would mean they would no longer be able to participate in the program. The Standard reports that if too many people opt out, there could be “serious financial consequences” and ultimately destroy the program.
