How Medicaid Can Help Pay for Long-Term Care in Washington State

Q: What is TSOA in Washington State?

Tailored Supports for Older Adults — a program with an asset limit of $84,354 for a single applicant, over 40 times higher than the standard $2,000 limit used by COPES and other Washington waivers. In exchange, TSOA caps its monthly benefit at around $830.

Q: What is the difference between COPES and TSOA?

COPES is Washington's primary HCBS waiver for those who need nursing-facility-level care, with the standard $2,000 asset limit and broader services. TSOA serves people with more savings who don't yet need intensive care, offering a smaller, capped monthly benefit in exchange for the much higher asset allowance.

Q: Does Washington still have an asset test for Medicare Savings Programs?

No — Washington eliminated asset limits for Medicare Savings Programs (QMB, SLMB, QI) effective 2026. Only income is checked now, making it meaningfully easier for seniors with modest savings to qualify.

Published August 28, 2026 How we keep this accurate

This page is Washington-specific. Medicaid long-term care rules vary significantly by state. See our national Medicaid Waivers Explained guide if you're elsewhere.

A program with a dramatically different asset limit

Washington's standard HCBS waiver, COPES, uses the familiar $2,000 asset limit. But the state also runs a second program — TSOA (Tailored Supports for Older Adults) — with an asset limit of $84,354 for a single applicant. That's over 40 times higher.

The trade-off: a capped, smaller benefit. TSOA provides a maximum of roughly $830/month in support — meaningfully less than COPES's broader coverage. It's designed for people who have more savings and don't yet need intensive nursing-facility-level care, giving them some help without requiring a full spend-down first.

COPES vs. TSOA, side by side

	COPES	TSOA
2026 asset limit (single)	$2,000	$84,354
Benefit level	Full range of HCBS services	Capped around $830/month
Who it's for	Those needing nursing-facility-level care	Those with more savings, lower current need

Source: Washington Aging and Long-Term Support Administration (ALTSA), DSHS; figures effective 2026.

COPES: Washington's primary waiver

COPES (Community Options Program Entry System) covers personal care, skilled nursing, adult day services, home modifications, and emergency response systems for seniors and disabled adults needing nursing-facility-level care. It's administered by ALTSA and is not an entitlement — enrollment is capped at roughly 62,450 slots per year, and waitlists can form once slots fill.

Other pathways worth knowing about

Washington has several similar-sounding but distinct programs: Medicaid Personal Care (a lower-bar state plan benefit, fewer services), New Freedom (a self-directed monthly budget, available only in certain counties), and Community First Choice (a state plan option overlapping with COPES). Which one actually fits your situation depends on your specific needs — worth asking a caseworker directly rather than assuming.

If your income is over the limit

Washington's Medically Needy program lets you spend down excess income on medical expenses to meet the $994/month limit — and unlike some states, you can choose a 3- or 6-month spend-down period, giving you some flexibility in how this is structured.

A connection worth knowing about, beyond long-term care

Washington eliminated asset limits for Medicare Savings Programs entirely, effective 2026. If you're also checking Medicare premium assistance, only your income matters now — no asset test at all. See our Medicare Savings by State guide.

How to actually start

Contact ALTSA at 1-800-422-3263 to begin a CARE (Comprehensive Assessment Reporting Evaluation) — this determines your level of need and which program actually fits.

If your savings are well above $2,000 but you don't yet need intensive care, ask specifically about TSOA rather than assuming you're ineligible for everything.

Common Questions

What is TSOA in Washington State?

A program with an $84,354 asset limit, over 40 times higher than standard waivers, offering a capped ~$830/month benefit for those with more savings and lower current care needs.

What is the difference between COPES and TSOA?

COPES serves those needing nursing-facility-level care with a standard $2,000 asset limit; TSOA serves those with more savings and lower needs, with a smaller capped benefit.

Does Washington still have an asset test for Medicare Savings Programs?

No — eliminated entirely as of 2026, only income is checked now.