For many families, the biggest question about Adult Family Home care is: how on earth do we pay for it?
In Washington State, the answer for thousands of families is the COPES waiver — a Medicaid program that covers AFH care for adults who qualify. If your loved one is on Medicaid or might qualify, this is one of the most important programs in the state to know about.
What is the COPES waiver?
COPES (Community Options Program Entry System) is a Medicaid 1915(c) waiver in Washington. It pays for long-term care services in community settings — including AFHs — for people who would otherwise need nursing home placement.
If approved, COPES typically covers:
- Personal care (bathing, dressing, eating, toileting)
- Medication management
- 24-hour supervision in a licensed AFH
- Some equipment and modifications
Who qualifies?
To qualify for COPES in WA, a person must meet both financial and functional eligibility.
Financial eligibility (2025-26 estimates)
- Income limit: roughly $2,829/month for an individual
- Asset limit: $2,000 for an individual
- Married couples have different limits (one spouse can keep more if the other is on Medicaid)
If income is over the limit, a Miller trust (qualified income trust) can sometimes be set up to redirect excess income and qualify. An elder law attorney can advise.
Functional eligibility
A WA DSHS case manager visits the applicant and completes a Comprehensive Assessment Reporting Evaluation (CARE). The applicant needs to score as needing nursing-home-level care to qualify for COPES.
How to apply
- Apply for Medicaid first at WashingtonConnection.org.
- Request a long-term care assessment with your local DSHS Home & Community Services (HCS) office. Find your local office at the DSHS HCS directory.
- Complete the CARE assessment with the DSHS case manager.
- Pick an AFH that accepts Medicaid. Not every AFH does — you'll want to filter specifically for Medicaid acceptance.
- Move in. Once approved, Medicaid pays the AFH directly.
The process takes 30–90 days typically. If your situation is urgent (e.g., hospital discharge), tell HCS — they can expedite.
Finding AFHs that accept Medicaid
Roughly 60–70% of WA AFHs accept Medicaid (COPES). Some accept Medicaid only after a private-pay "spend-down" period; others accept Medicaid from day one. Always ask directly.
On HomeFinder WA, the listings clearly indicate whether each home accepts Medicaid. Browse the directory to see homes by city.
What if my loved one doesn't qualify yet?
If income or assets are slightly over the limit, look into:
- Spend-down: Many families pay privately for the first 6–24 months while drawing down assets to qualify.
- Long-term care insurance: If a policy exists, AFHs typically accept it as private-pay.
- VA Aid & Attendance: Veterans and surviving spouses may qualify for up to ~$2,800/month additional benefit.
- Family contribution: Some families share costs across multiple adult children.
Frequently asked questions
Does Medicare cover Adult Family Home care?
No. Medicare doesn't cover long-term custodial care in any setting. Medicare may cover short-term rehab in a skilled nursing facility, but ongoing AFH care is a Medicaid (or private-pay) expense.
Can I be a paid caregiver for my own family member?
In some cases, yes — Washington has a program called Individual Provider (IP) that lets family members be paid caregivers, but this is a separate path from AFH placement.
If my loved one is on Medicaid, can they still pick any AFH?
Only those that accept Medicaid. About 60–70% of WA AFHs do. Always confirm before touring.
Ready to look? Find a Medicaid-accepted Adult Family Home in Washington.
