When families face the reality of long-term care costs in Washington State, Medicaid's Community Options Program Entry System (COPES) often becomes a lifeline. This program allows eligible individuals to receive care in community settings like adult family homes rather than nursing facilities, often at significant cost savings while maintaining quality of life.

Understanding how COPES works, who qualifies, and how to apply can make the difference between affordable care and financial hardship. This guide walks through everything you need to know about Washington's COPES program.

What Is COPES?

COPES stands for Community Options Program Entry System. It's Washington State's Medicaid waiver program that pays for long-term care services in community settings for individuals who would otherwise require nursing home care. The program is administered by the Department of Social and Health Services (DSHS) through local Home and Community Services (HCS) offices.

The core principle of COPES is choice: instead of requiring individuals to live in nursing homes to receive Medicaid long-term care benefits, COPES allows them to choose community-based alternatives that better fit their preferences and often cost less.

Care Settings Covered by COPES

  • Adult family homes: Residential homes caring for 2-8 adults
  • Assisted living facilities: Some facilities accept COPES (limited availability)
  • In-home care: Care provided in the individual's own home
  • Adult day programs: Daytime care and activities

COPES Eligibility Requirements

Qualifying for COPES requires meeting both functional (care need) and financial criteria.

Functional Eligibility

To qualify functionally, an individual must need nursing facility level of care. A DSHS case manager conducts an assessment using the Comprehensive Assessment Reporting Evaluation (CARE) tool to determine if someone meets this threshold. Generally, this means:

  • Requiring substantial assistance with activities of daily living (bathing, dressing, eating, toileting, mobility)
  • Having cognitive impairments requiring supervision (dementia, intellectual disabilities)
  • Needing skilled nursing services regularly
  • Having complex medical needs (ventilator, wound care, dialysis coordination)

Financial Eligibility

Financial requirements for COPES include:

  • Asset limit: $2,000 for individuals (certain assets are exempt, including primary home up to certain equity limits, one vehicle, personal belongings)
  • Income limit: Currently around $2,829/month for 2024, but those with higher income may still qualify through "medically needy" pathways
  • Spousal protections: When one spouse needs care, the healthy spouse can retain significantly more assets and income

The financial rules are complex, and many people assume they won't qualify when they actually can. Consulting with an elder law attorney or benefits specialist is often worthwhile.

How COPES Pays for Care

COPES uses a tiered payment system based on the assessed care level. Higher care needs result in higher payment rates.

Payment Structure

DSHS pays adult family homes directly at daily rates based on the resident's assessed classification:

  • Classification A (lowest): Approximately $85-100/day
  • Classification B: Approximately $100-130/day
  • Classification C: Approximately $130-170/day
  • Classification D: Approximately $170-220/day
  • Enhanced rates: Higher rates for specialized care (ventilator, behavioral, etc.)

Note: Exact rates are updated periodically by DSHS. Current rates can be found on the DSHS website or by contacting your local HCS office.

Resident Participation

COPES recipients contribute a portion of their income toward their care, called "participation." This is typically all income except a small personal needs allowance ($68.27/month in 2024). The COPES rate plus resident participation equals the total payment to the facility.

The COPES Application Process

Applying for COPES involves several steps and typically takes 4-6 weeks from initial application to approval.

Step 1: Initial Contact

Contact your local Home and Community Services office or call the DSHS toll-free line. You can also start the process while in the hospital—hospital social workers can help initiate applications.

Step 2: Financial Application

Submit a financial application with documentation including:

  • Social Security statements
  • Bank statements (3-6 months)
  • Investment account statements
  • Life insurance policies
  • Property deeds
  • Vehicle titles
  • Proof of citizenship or immigration status

Step 3: Functional Assessment

A DSHS case manager conducts the CARE assessment, either in person or by phone, to evaluate care needs. They'll gather information about:

  • Medical conditions and diagnoses
  • Ability to perform daily activities
  • Cognitive status
  • Behavioral concerns
  • Current care being received

Step 4: Care Planning

If approved, the case manager develops a care plan specifying what services COPES will cover. For adult family home residents, this determines the payment classification.

Step 5: Facility Selection

You choose an adult family home or other setting that accepts COPES and has availability. A placement agency like Seattle Assisted Living Network can help identify appropriate options.

Tips for a Successful COPES Application

Do:

  • Apply early—don't wait until funds are depleted
  • Gather documentation before starting the application
  • Be thorough when describing care needs during the assessment
  • Have medical records available to support care needs
  • Consider consulting an elder law attorney for complex situations
  • Respond promptly to any requests for additional information

Don't:

  • Give away assets to qualify—this can result in penalty periods
  • Underestimate care needs during the assessment
  • Assume you won't qualify without checking
  • Wait until a crisis to begin the process

Common Misconceptions About COPES

"My parent has too much income to qualify"

While income limits exist, Washington has "medically needy" pathways that allow higher-income individuals to qualify after meeting deductibles. Additionally, the spouse at home can retain significant income.

"They'll take my parent's house"

The family home is generally exempt from Medicaid asset calculations while the applicant or their spouse is living. After death, estate recovery may apply, but exemptions exist, and planning strategies can protect the home in many cases.

"COPES-funded care is lower quality"

Many excellent adult family homes accept COPES residents alongside private-pay residents. The care provided is the same—only the payment source differs. However, some premium homes are private-pay only, so options may be somewhat more limited.

When to Start the COPES Process

The best time to explore COPES eligibility is before you urgently need it. Consider starting the process when:

  • Your loved one's care needs are increasing
  • Private funds will last less than 2-3 years
  • A hospital stay suggests discharge to a care facility
  • Current care arrangements are no longer sustainable

Even if you're currently paying privately, understanding COPES eligibility helps with long-term planning and transitions.

Frequently Asked Questions

How long does COPES approval take?

Typically 4-6 weeks from complete application to approval, though complex cases may take longer. Emergency applications can be expedited when someone is being discharged from a hospital or faces an urgent care need.

Can I choose any adult family home with COPES?

You can choose any licensed adult family home that accepts COPES and has an available bed. Some homes are private-pay only, and others have limited COPES beds. A placement agency can help identify homes with COPES availability.

What if my loved one's needs change after COPES approval?

COPES recipients are reassessed periodically (typically annually) or when needs change significantly. If care needs increase, the classification and payment rate can be adjusted upward. The case manager can also modify the care plan as needed.

Can married couples both receive COPES?

Yes, both spouses can qualify for COPES if they both meet functional eligibility. Financial rules differ when both spouses need care—consult with DSHS or an elder law attorney for guidance on your specific situation.

Does COPES cover memory care?

Yes, COPES covers care for individuals with dementia and other cognitive conditions. Many adult family homes specialize in memory care and accept COPES residents. The assessment will consider cognitive impairments when determining care needs.