Washington Medicaid home care: COPES, Medicaid Personal Care and how to apply

Washington pays for care at home through two main Medicaid routes run by the Department of Social and Health Services (DSHS): Medicaid Personal Care for people who do not need nursing facility level care, and the COPES waiver for people who do. Relatives can be paid as individual providers, but DSHS says a spouse generally cannot.

The two main routes

DSHS describes Medicaid Personal Care (MPC) as a Medicaid State Plan program for clients who do not meet nursing facility level of care. It pays for help with activities of daily living such as bathing, dressing, eating, toilet use and transfers, and with some household tasks when the client also needs help with daily living tasks.

COPES, the Community Options Program Entry System, is a 1915(c) Medicaid waiver. The DSHS Long-Term Care Manual says it provides services to over 51,000 clients who live in their own homes, adult family homes or assisted living facilities, and that it was first established in 1982. Details are on our COPES page and our Medicaid Personal Care page.

Who runs what

• Health Care Authority: runs Apple Health, the state's Medicaid. Medicaid.gov lists 800-562-3022.
• DSHS Home and Community Services (HCS): assesses and authorizes long-term care for older adults and adults with disabilities. The manual says the COPES waiver is operated by the Home and Community Living Administration's Home and Community Services.
• Area Agencies on Aging (AAA): the manual says they contract with waiver providers and keep lists of contracted, eligible providers.
• Consumer Direct Washington: the contracted employer of individual providers.

Who can be paid to give care

DSHS says family members who provide care to a relative can become paid caregivers if the care recipient qualifies for Medicaid Long-Term Services and Supports. A family member can only be hired as an individual provider (IP), who is employed through the Consumer Direct Care Network of Washington. The client picks, schedules, supervises and can dismiss the IP, according to the manual.

The spouse rule is strict. DSHS says that under Apple Health and Long-Term Services and Supports you cannot be paid to care for your spouse. It names two exceptions: Veteran Directed Care, which may allow a veteran's spouse to be hired, and WA Cares, which will allow spouses to be paid caregivers if the person receiving care has earned WA Cares benefits and meets the required level of need. Our paid family caregiver page for Washington has the training steps.

How to start

1. Apple Health coverage. Medicaid.gov lists the Health Care Authority at 800-562-3022 for help with coverage.
2. A CARE assessment. The manual says functional eligibility is decided with the Comprehensive Assessment Reporting Evaluation (CARE). Contact DSHS Home and Community Services or your Area Agency on Aging to ask for one.
3. Authorization and a plan of care. The manual says all services must be in the client's plan of care and assigned to a paid provider before authorization.
4. Choose a provider. For in-home personal care that is an individual provider through Consumer Direct Washington, or a licensed home care agency under contract. Adult family homes and contracted assisted living facilities are other settings.

What we have not described

We read the DSHS manual chapters on COPES and Medicaid Personal Care and the DSHS pages on paid caregivers. We did not read DSHS pages on Medicaid Alternative Care, Tailored Supports for Older Adults, the Family Caregiver Support Program, Veteran Directed Care, WA Cares or the developmental disabilities waivers, so we do not describe how they work. Ask DSHS or your Area Agency on Aging.

We state no pay rates and no income or asset limits. The DSHS pages we read do not give a current dollar figure, and the manual points to its financial eligibility chapter, which we did not read.

Questions to ask when you call

• Do I meet nursing facility level of care, which decides between Medicaid Personal Care and COPES?
• If I want a relative paid, are they eligible to be hired as an individual provider, and is my spouse one of the cases DSHS names as an exception?
• Is the provider I want contracted with the Area Agency on Aging?
• Who is my case manager, and who do I call if hours or payments go wrong?

Terms you will see

• CARE: the assessment tool DSHS uses to set functional eligibility and hours.
• CFC: Community First Choice, a State Plan program the manual says COPES services wrap around.
• IP: individual provider, a caregiver employed through Consumer Direct Washington.
• AAA: Area Agency on Aging, the local office that contracts providers.

Where Carevo fits

Carevo is a connection platform and directory. We do not run these programs, assess eligibility, set hours or vouch for any provider. For paid help while you wait, see home care in Washington, home health in Washington, nursing homes in Washington and developmental disability services in Washington.

Programs in Washington

• Community Options Program Entry System (COPES): COPES is Washington's Medicaid waiver for people who meet nursing facility level of care but want to stay in the community. DSHS says it serves over 51,000 clients at home, in adult family homes and in assisted living.
• Medicaid Personal Care (MPC): Medicaid Personal Care pays for help with daily living at home for Washington adults who do not meet nursing facility level of care. You can choose an individual provider employed through Consumer Direct Washington or a licensed agency.

Find providers in Washington

• Home care in Washington
• Home health care in Washington
• Nursing homes in Washington
• Intellectual and developmental disability services in Washington
• Paid family caregiver in Washington