A look at what WA's long-term care benefit might pay for

What could Washington's new $36,500 lifetime long-term care benefit get you?

According to a state workgroup, about 2,281 home-delivered meals, 80 days in an adult family home, seven years of transportation services, or $15,000 worth of adaptive equipment and technology to help with a disability.

The Long-Term Services and Supports Trust Commission, a group of lawmakers, state agency representatives, long-term care workers and beneficiaries, is in the process of finalizing the rates that the WA Cares Fund will pay for certain services.

The state applies a 0.58% tax on most Washington workers' paychecks to fund the program. Beginning in July 2026, those who qualify can access funds to offset expenses for things like caretaking, equipment and medication.

An initiative on the ballot this November, if passed, would amend the program so workers can opt out of paying the tax and getting the benefit at any time. That could have steep financial consequences and make the program ultimately unsustainable if too many workers decide they don't want to participate.

Under the program, the maximum benefit an eligible resident could receive is $36,500. The state plans to adjust that capped amount over time for inflation.

At a Wednesday meeting, the commission voted on final recommendations for how the benefit can be used for equipment, home-delivered meals, personal emergency response systems and home modifications. The commission approved those proposed rates unanimously.

Commissioners also discussed rate recommendations for other services, including adult day care, transportation, time off for family caregivers and in-home care. Those recommendations will get a vote at a future commission meeting before being sent to the Department of Social and Health Services which will finalize the rates in a rulemaking process.

"It was not super easy to conclude this," said commissioner Mark Stensager, who helped lead the rate setting work group. "This is complicated, and we considered what it was going to be like for consumers to figure out how to use their benefits."

The group looked at both Medicaid rates as well as commercial rates analyzed by Milliman, a risk management firm who has done actuarial analyses on the program.

Stensager said they decided to go with commercial rates as opposed to Medicaid rates to give people as much flexibility as possible in using their benefit, allowing them to choose either low or high cost providers.

There are some exceptions to the rates, and the commission gives the Department of Social and Health Services the ability to allow the benefit to cover more than the maximum rate, if a circumstance calls for it. Some rates could also vary depending on geographical location.

The rates

For some less expensive services, like meal delivery, equipment upgrades or daily transportation, WA Cares may cover most of what's needed.

The benefit could pay up to $16 per home-delivered meal, $400 a month for transportation reimbursements, or $15,000 for equipment like wheelchairs or technology like screen readers or braille devices.

To give breaks to family caregivers, the benefit could also provide up to $45 an hour for in-home caregivers or up to $325 a day for adult day care to give breaks to family caregivers.

For more expensive services, however, like adult family homes or assisted living facilities, the benefit may not go as far.

The fund will pay for up to $455 a day in an adult family home, $540 a day in an assisted living facility and up to $535 a day in a nursing home. According to the commission, providers cannot charge the maximum amount unless they justify the cost in a resident assessment.

Costs for a private room at a nursing home in Washington state averaged $450 a day in 2023, according to estimates from Genworth, a company that offers private long-term care insurance.

The state encourages those using Washington's public benefit to combine it with other payment options, and Stensager said beneficiaries 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," said Andrea Meewes Sanchez, chief of policy and planning for WA Cares at the Department of Social and Health Services. "We don't want people to receive surprise billing."

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