WA Cares readies for May 18 launch after pilot shows quick processing but provider gaps remain

Portia Everson, the meeting facilitator, opened the LTSS Trust Commission’s April 29 session with a program refresh and timeline for WA Cares’ public launch. Andrea Miva Sanchez, executive administrator for the WA Cares Fund at the Department of Social and Health Services, said the fund will begin accepting applications statewide on May 18, with benefit payments starting July 1.

Sanchez said WA Cares is a public long-term care insurance program funded by a payroll contribution of just over half a percent. “Once approved, the person receiving care gets to choose how they use their $36,500 benefit,” Sanchez said, adding that the lifetime benefit amount will grow with inflation and the program has no deductible or waiting period.

The Commission heard that eligibility is based on both contribution history and functional need. Sanchez outlined three pathways to benefits: a permanent pathway after at least 10 years of contributions; a temporary pathway for those who have contributed at least three of the previous six years; and a transition pathway for people born before Jan. 1, 1968 that prorates benefits by year of contribution. She reiterated the functional eligibility standard used in assessments: assistance with three or more activities of daily living for at least 90 days.

Commission staff presented pilot results from a small, early rollout. Alina Tortellot, WA Cares data program analytics and strategy administrator at DSHS, said the pilot launched Jan. 6 and closed in March. Of 10 organic pilot applicants (24 additional volunteers were used for system testing), eight met the contribution requirement and seven completed functional assessments and became eligible. The average time between contribution determination and completing an assessment was eight days, substantially below the 45-day statutory target.

Elena (data lead) provided detail on preauthorizations and claims: three preauthorizations were approved in the pilot, totaling roughly $8,300 held for services, and there were about $1,300 in paid or soon-to-be-paid claims. Participants in the pilot were from Thurston and Spokane counties only.

Commissioners pressed staff on provider network adequacy. Ben Vechte, director of the WA Cares Fund at DSHS, said 428 provider applications have been registered and about 300 more are in the pipeline. “We’re staffing up our data team,” Vechte said, and the program has been modeling county-by-county needs and service-type goals to prevent service deserts. Andrea added that, by service type, the program currently has 102 registered home-care agencies (82 in the pipeline) and 16 registered home-delivered meals providers (14 in the pipeline), and that staff will present more detailed county-level provider data at the June meeting.

Staff told commissioners they have developed an expedited process for registering providers who are already serving a beneficiary and emphasized the continued importance of human support in intake and assessment work. “While we’ve made every effort to develop user-friendly accessible systems, participants still need assistance navigating processes, and the human touch points for WA Cares in our intake and assessment are critical,” Vechte said.

The Commission requested additional metrics for the June meeting, including provider counts by service and county, provider language-access demographics, timeliness and claims reporting (claims data is lagged and expected in September), and any critical operational issues arising after the May 18 go-live. Staff committed to immediate notification to the Commission of any serious disruptions after launch.

The Commission’s next regular meeting is set for June 24, where staff will present the first full statewide program metrics after the May 18 launch.