Long-term services and supports (LTSS)/hospice

Find information about eligibility for long-term services and supports (LTSS), and hospice.

Apply for or renew Apple Health coverage through:

Washington Connection

Program requirements

Long-term services and supports (LTSS)

Apple Health pays for services in your home, a community residential care facility, assisted living facility, adult family home, or nursing facility if you meet certain criteria based on an assessment.

LTSS programs are tailored to fit individual needs and situations. Home and Community Based (HCB) Services, such as the COPES waiver and DDA waivers or Community First Choice, enable people to continue living in their homes with assistance to meet their physical, medical, and social needs. When these needs cannot be met at home, care in a residential or nursing facility is available.

Different income and resource standards apply to LTSS coverage. A person must meet both financial eligibility rules and comprehensive assessment requirements to be eligible for LTSS programs.

Please note: For LTSS provided under the Apple Health for Adults programs, only income limits apply.

Hospice

Hospice is a 24-hour intermittent program coordinated by a hospice interdisciplinary team for persons with a terminal illness and a prognosis of six months or less to live. The hospice program allows the terminally ill client to choose physical, pastoral/spiritual and psychosocial comfort, and palliative care rather than cure. Hospitalization is used only for acute symptom management.

Hospice care is initiated by the choice of the client, family or physician. The client’s physician must certify a client as appropriate for hospice care. Hospice can be ended at any time by the client or family (revocation) by the hospice agency (discharge).

Hospice care may be in a client’s home, in a medical institution including a hospice care center, nursing facility or in an alternate living facility.

Hospice is a covered service under most Apple Health programs; however, if you do not qualify for Apple Health through the Washington Healthplanfinder, you may be eligible for coverage under the Hospice Program, which has higher income and resources standards.

Applying for Apple Health coverage

Enrollment next steps

LTSS services begin once you have been determined to meet nursing-facility level of care and you have a caregiver in place to provide services. You'll receive a Services Card about two weeks after your application is processed and you're found eligible. Apple Health coverage will begin on the first day of the month in which the application was submitted if you're eligible for LTSS that month. You'll be auto-enrolled into a managed care plan, unless you have Medicare, other comprehensive insurance, or live in a nursing facility.

Contact

For your local Home and Community Services office
Online:
 Visit the DSHS site for office locations