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Long-term services and supports (LTSS) and hospice
Find information about eligibility for long-term services and supports (LTSS), and hospice.
Long-term services and supports (LTSS)
Apple Health helps pay for care if you meet certain criteria based on your finances and a functional assessment. The care may be provided in the following settings:
- Your home
- An alternate living facility such as a:
- Community residential care facility
- Assisted living facility
- Adult family home
- A nursing facility
LTSS programs are tailored to fit individual needs and situations. Home and Community Based (HCB) services enable people to continue living in their homes with assistance to meet their physical, medical, and social needs. Examples include the Home and Community Services (HCS) and Developmental Disabilities Administration (DDA) waivers or Community First Choice (CFC). When these needs can't 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 and comprehensive functional assessment requirements to be eligible for LTSS programs. View the LTSS fact sheet.
Please note: For LTSS provided under the Apple Health for Adults programs, only income limits apply.
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, psychosocial comfort, and palliative care rather than a 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 revoked at any time by the client or family, or 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 don't 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.
- Online: Visit Washington Connection and click on "See If I Qualify".
- Paper application: Print and complete Form 18-005, and mail it to the Washington State Department of Social and Health Services (DSHS): DSHS Home and Community Services, P.O. Box 45826, Olympia, WA 98504-5826.
- In person: Visit a Home and Community Services office. Visit the DSHS site for office locations.
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.