Washington state’s new, long-term care insurance program gives residents a lifetime benefit of $36,500, which can pay for approximately 81 days in a nursing home.
The benefit is a first-in-the-nation payroll tax plan for long-term care costs and as such has been closely watched by the provider and insurance industries.
The benefit can be used to pay up to $535 per day in a nursing home. The average cost for a private room in a nursing home in 2023 in Washington state was $450 per day, according to Genworth, a company that offers private long-term care insurance.
The Long-Term Services and Supports Trust Commission — composed of lawmakers, state agency representatives, long-term care workers and beneficiaries — is putting the final touches on how much state residents could pay for services under the WA Cares program, per reporting from the Washington State Standard.
“Funding from WA Cares can help, but the cap means that facilities are still struggling to cover the costs of care for residents with more expensive needs,” Carma Matti-Jackson, president/CEO of the Washington Health Care Association told McKnight’s Long-Term Care News on Friday. “Skilled nursing facilities in Washington need more financial support, as the cost of providing care continues to increase. At this time, we are focused on getting the Medicaid rates to cover the cost of care for Medicaid insured individuals so that these costs do not need to be subsidized by other payers.”
The commission has said that providers must justify costs in a resident assessment if they want to charge the maximum allowable amount.
On July 1, 2023, the state began collecting a 0.58% tax on every $100 of most workers’ paychecks for the program. Qualified, eligible residents can begin using the benefit, which can be used for a multitude of services to help aging seniors either stay in their homes and transition to a care facility. Services the benefit can pay for include medication management; daily living activities such as bathing, easting, and mobility; stays in long-term care facilities; and equipment.
The Washington State Standard reporting notes that the program could cover full costs for less expensive services such as meal deliveries or daily transportation. But coverage for nursing homes and other facility stays “may not go as far.”
State officials have suggested that seniors combine the WA Cares benefit with other public benefits, and that people “should be strategic in how they use their benefits to pay for more expensive services.”
“If people would like to blend private pay with WA Cares, they can, but what they pay can’t exceed that maximum rate,” Andrea Meewes Sanchez, chief of policy and planning for WA Cares at the Department of Social and Health Services, said in the Standard article. “We don’t want people to receive surprise billing.”
Washington state voters will consider a ballot initiative in the November election that would let people opt out of the tax, which would prevent them from participating in the program. The Standard reporting notes that there could be “steep financial consequences” that could ultimately doom the program if too many people opt out.
