Medicaid

Overview

Medicaid in the United States is a federal and state program that helps with medical costs for some people with limited income and resources. Medicaid provides needed health care services for low-income individuals including families with children, seniors, persons with disabilities, foster care and pregnant women. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services.

Benefits

Medicaid can assist with costs associated with hospitalizations, doctor visits, labs, x-rays, physical, speech and occupational therapy, medically necessary durable medical equipment, short term skilled nursing care and in-home skilled nursing care (home health). Medicaid covers some long term custodial care services such as:

  • In-Home Support Services (COPES): This program allows eligible individuals to have a caregiver to assist with custodial care such as bathing, dressing, light housekeeping, meal preparation, laundry, grooming, transportation, etc.
  • Long Term Care: Medicaid does have a long term care component for eligible individuals that need long term placement in a nursing facility, Adult Family Home (AFH) or Assisted Living Facility (ALF).

Eligibility

In order to qualify for this benefit program, you must be a resident of the state of Washington, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be either pregnant, a parent or relative caretaker of a dependent child(ren) under age 19, blind, have a disability or a family member in your household with a disability, or be 65 years of age or older.

In order to qualify, you must have an annual household income (before taxes) that is less than or equal to the following amounts:

2025 Numbers

Household size*             Maximum Annual Income
1                                           $21,600
2                                           $29,196
3                                           $36,780
4                                           $44,364
5                                           $51,960
6                                           $59,544
7                                           $67,140

*The income standards listed in these examples are subject to change annually every April.

Additional Information

When you’re ready to apply, you’ll need:

  • Your household monthly income.
  • Your immigration information, if that applies to you.
  • Dates of birth for each member of your household.
  • Social Security numbers (SSN) for each household member who is applying for coverage and has a SSN. Some programs do not require a SSN.

If you’re accepted, you’ll receive a ProviderOne services card in about two weeks. Coverage will begin on the first day of the month in which the application was submitted. You’ll have the option to select a managed care plan online or you’ll be auto-enrolled into a plan.

 

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