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WA Cares officials outline program design, eligibility and January pilot
Summary
DSHS officials updated the Long Term Services and Supports Trust Commission on WA Cares program design: a 58¢ per $100 premium, a $36,500 lifetime benefit, three benefit pathways, and a January pilot that will accept 400 applicants in four counties to test eligibility, assessments and provider workflows.
Andrea Miva Sanchez, executive administrator for WA Cares at the Department of Social and Health Services, gave the commission a refresher on the program's design and launch timeline. She said the premium rate for the program is "58¢ for every $100 earned" and that the lifetime benefit is $36,500, adjusted annually for inflation. Sanchez outlined three pathways to benefits: contributing for 10 years; contributing 3 of the last 6 years; and a near‑retiree pathway where people born before 1968 earn a portion of the benefit for each year they contributed.
Sanchez described the eligibility process: applicants create a WA Cares account, the employment verification with the Employment Security Department runs (an overnight process), and DSHS conducts an in‑person or virtual assessment to determine whether an applicant needs help with at least three activities of daily living for 90 days or more. "After that point, DSHS has up to 45 days to do an in‑home care assessment to figure out if folks are eligible," she said, adding that applicants receive a letter explaining eligibility and appeal rights, including the option to appeal to the Office of Administrative Hearings.
DSHS said the pilot opens in January and will accept applications for 400 individuals in Lewis, Mason, Thurston and Spokane counties; applications will close March 31 and program staff will incorporate lessons learned in April ahead of a statewide launch that will open applications May 18 and begin benefit payments July 1, 2026. The pilot is intended to test the application workflow, phone and self‑service channels, the assessment process, provider authorizations and the online account features that let beneficiaries monitor balances and authorize trusted representatives.
Commissioners pressed agency staff on timing for urgent cases, triage and expedited processing. Sanchez said the 45‑day statutory window is a maximum and that DSHS expects many assessments will be completed more quickly; staff also plan to leverage area agencies on aging and community assisters for in‑person support. "We don't expect all of our assessments to take 45 days. That's a maximum that we're looking at for assessments," she said. Officials said they will track wait‑time metrics during the pilot and report findings to the commission.
The presentation also noted access and language supports: a centralized WA Cares +1 800 number routed to DSHS, live interpretation and translated materials, plus the ability for beneficiaries to grant authorized users access to accounts. Sanchez said providers will be paid directly for the majority of services and that a provider directory and online approval/authorization tools will be available.
Next steps identified for commissioners include monitoring pilot performance metrics (call wait times, assessment timeliness, provider onboarding) and reporting pilot findings at the April meeting.
