QUESTIONS AND ANSWERS ON THE COPES P

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Community Options Program Entry System Waiver (COPES)

You can find all the fact sheets we link to here at .

What is the COPES program?

The COPES program pays for long-term care in your home or in a community setting, like an assisted living or an adult family home. Long-term care can include help from a trained caregiver to shower, dress, eat, use the toilet, walk, change position in bed, and manage your medications. The COPES program is administered by the Washington State Department of Social and Health Services (DSHS).

How do I get COPES program coverage?

You can apply online through the DSHS website at home or go to your local DSHS ofice. Use the ofice locator at dshs.ofice-locations to ind an ofice near you. You can ask DSHS for help applying for the program. Read DSHS Help for People with Disabilities: Necessary Supplemental Accommodations to learn more.

After you apply, DSHS will decide if you are: (1) inancially eligible and (2) "functionally" eligible for the COPES program. You're inancially eligible for COPES if your income and resources are below set limits. You're functionally eligible for COPES if you need help with daily activities due to your disabilities.

What is the income limit for COPES?

The income limit for COPES is 300% (or 3 times) the Federal Beneit Rate (FBR). The FBR is the maximum amount of Supplemental Security Income (SSI) someone can get. If you're married and your spouse is not applying for COPES, DSHS will not look at their income to decide if you're inancially eligible. (Once you're approved for COPES, DSHS will look at your spouse's income to decide how much you and your spouse can afford to pay for your care). Income limits are adjusted each year and can be found at bit.ly/4fzQ8rQ. Scroll down and look for "Medicaid Special Income Level (SIL)" on the most recent chart.

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For example, in January 2024, the FBR was $943/month. So, the income limit for COPES is $2,829/month ($943 x 3). DSHS offers some income reductions, so you might be eligible for COPES even if your income is higher.

What is the resource limit for COPES?

The resource limit for one person is $2,000. But DSHS doesn't count all resources. Some resources, like your house, car, and personal items are considered "exempt" and don't get counted. If you're married and your spouse is also applying for COPES, the resource limit for both of you is $3,000. If you're married and your spouse is not applying for COPES, they can keep more resources. Resource Limits are adjusted each year and can be found at bit.ly/4fzQ8rQ. Scroll down and look for "SSI Resources," "State Spousal Resources," and "Federal Spousal Resource Maximum" on the most recent chart.

For example, in January 2023, the resource limit for a married couple where only one spouse is applying for COPES is $68,301 (plus the $2,000 already allowed) if they're living at home and up to $154,140 if the COPES spouse is living in a hospital or nursing home. DSHS will sometimes let a couple keep more resources if their income is lower than the CFC income limit.

How will DSHS decide if I'm "functionally" eligible for COPES?

Once DSHS decides you're inancially eligible for COPES, it will decide if you're "functionally" eligible for COPES. A case manager will interview you and others to ind out about your disabilities and what kind of help you need. The case manager will ask you if you need help with eating, bathing, toileting, moving your body, walking, and managing your medication. The case manager will also ask about any moods, behaviors, or cognitive problems that might disrupt your daily life.

When does COPES coverage start?

Coverage starts when DSHS approves your COPES application. There is no retroactive coverage for COPES.

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Will I get regular medical coverage too?

Yes. All COPES recipients get Medicaid coverage for other medical expenses like physician services, prescription drug, and home health services.

Can I get help with my Medicare premiums if I get COPES?

Yes. If you're eligible for COPES, you're also eligible for the Qualiied Medicare Beneiciary (QMB) program. The QMB program pays your Medicare premiums, copayments, and deductibles. You can ind out more about QMB and other Medicare Savings Programs on .

Will I pay anything for my COPES care if I live at home?

Maybe. It depends on your income and whether your spouse gets COPES too. Income limits are adjusted each year and can be found at bit.ly/4fzQ8rQ (scroll down look for "FBR (SSI Standard)" and "Medicaid Special Income Level (SIL)" on the most recent chart). If you're single and you live at home, you can keep up to 300% (or 3 times) the Federal Beneit Rate (FBR) amount. The FBR is the maximum amount of Supplemental Security Income (SSI) someone can get. You must pay any income left over for your care. If you're married, your spouse is also on COPES, and you both live at home, you can each keep up to up to 300% (or 3 times) the FBR amount. You must pay any income left over for your care. If you're married, but your spouse is not on COPES, you can keep up to the FBR amount only. You must pay any income left over for your care.

For example, in January 2024, the FBR was $943/month. So, if you're single and live at home, you can keep up to $2,829/month. If you're married, you both are on COPES, and you both live at home, you can each keep up to $2,829/ month. If you're married, your spouse is not on COPES, and you live at home, you can keep $943/month.

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Will I pay anything for my COPES care if I live in a residential community?

Probably. If you live in a residential community, like an assisted living or adult family home, you can keep a "personal needs allowance" (PNA). The rest of your income will usually go to pay for your care, room, and board. Some of your income can be set aside for special purposes, including guardian or conservator fees, child support, medical expenses, dependent family member care, and a "Community Spouse Allowance" if you're married. The PNA is updated annually and can be found here: bit.ly/4fzQ8rQ. Scroll down and look for "All other PNA Medical Institutions" on the most recent chart.

For example, in January 2024 the PNA was $103.20. So you can keep $103.20/month for personal needs and the rest of your income will pay for your care, room and board.

Can my spouse keep some of my income if I live at home?

Maybe. If your spouse does not get COPES, they can keep all the income paid in their name, no matter how much. They can also keep as much of your income needed to get up to the "Community Spouse Allowance" (CSA). The CSA is updated quarterly and can be found at bit.ly/4fzQ8rQ. Scroll down and look for "CS & Dependent Allowance" on the most recent chart.

For example, in July 2024 the CSA was $2,555. So if your spouse gets $2,000/month income in their name, they can keep $555/month of your income. The CSA can sometimes be increased if your housing costs are high.

Can my spouse keep some of my income if I live in a residential community?

Maybe. Most of your income will go to pay for your care, room, and board. There may not be any income left for your spouse to keep. But if your spouse's housing costs are high, talk to your DSHS worker about letting your spouse keep more of your income.

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What resources can I keep?

You can keep up to $2,000 of non-exempt resources. You can also keep exempt resources, including the home where you live, household goods, personal effects, one car, most burial plans, and life insurance policies. Read What can I buy and still be eligible for SSI and/or Medicaid? to learn more.

Can I give my home to my spouse, sibling, or child?

Maybe. There is no penalty when you transfer your home to: ? Your spouse. ? Your disabled child. ? Your sibling who has an equity interest in the home and lived there at least 1 year before you got COPES.

Your child who lived in the home and cared for you at least 2 years before you got COPES. (Your child must provide proof that they provided care.)

Can I give my resources to someone else?

Maybe. But be careful! If you give away resources during the 5 years before you apply for COPES or while you're getting COPES, you might not get COPES, or your COPES might stop for a period ("penalty period"). There is no penalty when:

? You sell a resource for fair market value. ? You give away an exempt resource other than your home. You give a gift or gifts equal to or less than the Daily Private Nursing Facility Rate in any calendar month.

For example, in January 2024, the Daily Private Nursing Facility Rate was $391. So you can give up to $391/month. You can find the Private Nursing Facility Rate here: bit.ly/4fzQ8rQ. Scroll down and look for "Daily Private NF Rate" on the most recent chart.

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