Nation’s first state-run long-term care insurance program launches in WA

It's a landmark moment for the endeavor known as WA Cares, envisioned as a means to help Washington's workforce afford long-term care and services as they age.

Starting Wednesday, insurance coverage through the state-run program will begin. Dozens of applications for benefits have already rolled in.

It's been a bumpy journey since majority Democrats in the state Legislature approved its creation in 2019 over the objections of Republicans. The program has undergone much retooling due to legislative action and public debate. And, two years ago, it survived an attempt to end it through a ballot measure.

Eligible individuals will be able to use their benefits to obtain services like in-home caretaking, equipment to help with getting around, medications, and meal delivery. The state will pay authorized providers from a fund in which premiums paid by an estimated 3.7 million Washington workers are deposited.

"We are changing what it means to age and age with purpose and age with dignity, and more importantly, aging in the homes where people want to be, to live those lives filled with purpose and dignity," Cathy MacCaul, advocacy director for AARP Washington, said at a news conference in Tukwila on Tuesday.

MacCaul, in a separate interview, said that while it is "a really exciting milestone," there is still more work to do. Specifically, she cited the need to clarify how family caregivers are involved, and to enlist more nursing homes, adult family homes and assisted living facilities.

Meanwhile, the safety-net entitlement is viewed as a test case for the country at a time when many states are coping with rising costs of care for aging populations.

"I'd be surprised if we get a few years down the road, and other states aren't starting to follow this model," said Gov. Bob Ferguson.

"Washington is making history by being the first to launch a public solution to the long-term care crisis that forces too many people further into debt every year," said House Speaker Laurie Jinkins, D-Tacoma, who authored the 2019 legislation.

How it works

WA Cares is funded with a 0.58% tax on the paychecks of workers in Washington. It amounts to just under $25 a month for those earning $50,000 a year, rising to $39 a month for those making $80,000.

Collections began in July 2023. A person pays as long as they are working in the state. Deductions stop if they retire, become unemployed or leave the workforce, and resume if they return to work.

Starting Wednesday, those living in Washington who qualify can begin accessing the benefit, which has a maximum benefit of $36,500, an amount that will rise over time for inflation. Eligible beneficiaries living out of state can tap into benefits starting July 1, 2030.

To be eligible for the full benefit, one must contribute for 10 years, or pay in for three years within the last six from the date they apply for benefits. Near-retirees, defined as those born before 1968, who do not become eligible for the full amount, will earn a pro-rated share of 10% for each year they work.

For all pathways, a person must work at least 500 hours annually for the year to count toward their eligibility for the program.

In addition, a person must demonstrate a need for help with at least three activities of daily living for at least 90 days. An employee of the state Department of Social and Health Services will conduct an in-home assessment of the person's living situation.

The process of applying and learning one's eligibility and benefit amount is anticipated to take a couple weeks.

People could start applying in May and 113 applications had come in as of June 22, according to state tallies. Of those, 44 people were deemed eligible. Up to that point, nearly $1.2 million in services had been authorized.

It is estimated 25,000 people will access benefits in the first year and 130,000 in the next decade, said Bea Rector, assistant secretary for the Department of Social and Health Services.

Program officials believe they've signed up enough providers in every county for what they think will be the most sought services, such as home-delivered meals, adaptive equipment, transportation, housework, yard work, errands and in-home personal care.

They've acknowledged they are well below their targets in areas like adult family homes, nursing homes and assisted living facilities, as well as providers of adult day services and home safety evaluations.

MacCaul said one challenge is that facility operators may need to buy additional coverage to meet the state's insurance requirement for this program. They worry they won't be able to recoup that cost because there is no guarantee of receiving WA Cares clients, she said.

A long road

WA Cares was supposed to start sooner. But, from the outset, the program faced criticism for its mandatory nature and failing to make the benefits portable, so if a person moved out of state after paying into the fund, they would be able to access the benefits.

As concerns multiplied, the Legislature in the 2022 session delayed the planned start by 18 months.

That session, and each one since, lawmakers made changes to address concerns. A revision in 2024 addressed the portability issue, for example.

Last year, lawmakers acted to allow workers who opted out of WA Cares because they had private long-term care insurance to get back in. And they opened a path for private insurers to create supplemental insurance policies for individuals with WA Cares benefits.

People who rescind their exemptions from paying the tax and join the state program must do so by July 1, 2028.

The strength of the program's finances is an ongoing concern. State actuaries estimate that it is currently solvent for 75 years.

It will help that voters last year amended the state constitution to allow the Washington State Investment Board to legally handle the program's assets as it does state worker pension and retirement accounts. The WA Cares fund had a balance of over $3.3 billion at the end of 2025.

There is language in the 2019 law intended to prevent those dollars from being swept toward other state spending.

"My biggest concern when we worked on the legislation," MacCaul said, "was that I could see a future where there is a struggle with a budget and there will be money in the trust fund and it will look very attractive."