How to Assist a Resident Who Needs to Apply for Medicaid

Follow the steps below when you have a resident who needs to apply for Medicaid coverage in order to receive Long-term Care Services and Supports.

** Please note – It is highly encouraged that all clients who are admitted to an Adult Family Home have a Representative Payee or a Power of Attorney in place prior to admission to assist with this process. It is crucial this happen prior to cognitive deficits appearing as a result of dementia.

1. Start with determining your client’s age

· Individuals under the age of 65 will likely be covered under an Apple Health program, which is managed through the Health Care Authority (HCA). Once they turn 65, they need to apply for Medicaid under Long-Term Services and Supports, which is offered through Home and Community Services (HCS).

 ~ The application can be submitted online via this link to begin this process:               https://www.washingtonconnection.org/home/

~ Providers are encouraged to sign the financial application as a representative authorized to help with the financial application. **Note – this is only for the application for Medicaid. The provider cannot sign as a representative in any other circumstance.

. Residents who are not alert & oriented will need either a Power of Attorney or a Representative Payee. Please note that obtaining a Rep Payee can take months. It is crucial one of these be in place prior to dementia affecting cognition.

2. If the resident is over the age of 65 and applying for coverage once they have completed their spend down:

· Applications must be submitted no less than 45 days prior to the client exhausting their funds using this link: https://www.washingtonconnection.org/home/

~ Due to potential delays in obtaining information related to financial eligibility, it is highly encouraged to apply 60-90 days prior to exhausting funds.

3. If experiencing delays in financial eligibility application processing times:

· Reach out to the Adult Family Home Council. The following information will be needed in order to escalate the concerns:

 ~ Client Name

~ Client date of birth

~ AFH Name

~ AFH License Number

~ Date application submitted

~ Application number, if known.

Resources:

Application link for clients age 65 and older: ~ https://www.washingtonconnection.org/home/

Application link for clients age 64 and younger, or for clients who do not qualify for Medicaid but require behavior supports through a Managed Care Organization: ~ https://www.wahealthplanfinder.org

Application link for a client who requires a Representative Payee: ~ https://www.ssa.gov/myaccount/rep-payee.html