Washington's long-term care program nears liftoff
(Getty Images)
A year from now, Washington will launch the nation's first full-scale effort to help the state's workforce afford long-term care and services as they age.
Etched into law in 2019, the public long-term care insurance program known as WA Cares survived an attempt to torpedo it at the ballot box last year. Already, $2 billion in tax collections have been banked in the program's trust fund through the end of March.
Lawmakers continue to fine-tune the program ahead of its rollout next summer.
This past legislative session brought revisions intended to welcome back thousands of people who opted out of the program and to unite the state-run, worker-funded entitlement with private long-term care insurers.
'It's a test case for the nation. It's going to be amazing when we roll it out,' said Cathy Knight, state director of the Washington Association of Area Agencies on Aging. 'We've needed something like this for a long time. It's not perfect. But for people going through a difficult time, it will be a tremendous help.'
Other states are watching. Like Washington, they face rising costs of care for an aging population, tight state budgets and uncertainties around federal support for Medicaid, said Ben Veghte, director of WA Cares for the Department of Social and Health Services.
'Nobody wants to leave families unprotected dealing with this risk,' he said. 'This is seen by many states as a promising model.'
WA Cares is funded with a 0.58% tax on the paychecks of workers in Washington. It amounts to just under $25 a month for those earning $50,000 a year, rising to $39 a month for those making $80,000 annually.
Collections by the state began in July 2023. A person pays as long as they are working in the state. Deductions stop if they retire, become unemployed or leave the workforce, and resume if the person returns to work.
Beginning on July 1, 2026, those living in Washington who qualify can begin accessing the long-term care benefit, which has a lifetime cap of $36,500, adjusted over time for inflation. Eligible beneficiaries living out of state can tap into benefits starting July 1, 2030.
The money can be used to offset expenses like in-home caretaking, respite for family caregivers, equipment, medication and meals for people who are older, injured or disabled. In all, 19 different types of services are covered.
There are two paths to becoming eligible for the full benefit amount – contribute for 10 years or pay in for three years within the last six from the date they apply for benefits. Near-retirees, defined as those born before 1968, who do not become eligible for the full amount will earn a pro-rated share of 10% for each year they work.
A person must work at least 500 hours during the year to earn a qualifying year.
Not every worker is in the program. Before the state started collecting payroll taxes — deemed premiums by the state — those with qualifying private long-term care insurance could opt out. An estimated 413,000 individuals chose this option, according to the Employment Security Department.
This program has faced criticism since its inception.
Some objected to its mandatory nature. Others said it was unfair that if someone stopped working for a while, then returned, they lost credit for the contributions made before the break.
Critics and supporters said there should be exemptions for people who work in Washington but live out of state. And there was pressure to make the benefits 'portable,' so if a person moved out of state after paying into the fund, they would be able to access the benefits.
As the pile of concerns grew, the Legislature passed a law in January 2022 delaying the start of payroll tax collections and delivery of benefits by 18 months, providing time to retool in response to critiques.
Changes made since then allow older workers nearing retirement to get partial benefits. The list of exemptions expanded to include people who live outside of Washington but work in the state, spouses of active-duty military service members, those with non-immigrant work visas, and veterans who meet certain disability requirements.
Meanwhile, Let's Go Washington, a conservative political committee, capitalized on the frustrations in 2023, gathering 424,000 voter signatures to put an initiative targeting the program on the ballot. That measure, which was in front of voters last November, sought to make participation voluntary rather than mandatory, allowing workers to opt out whenever they want. Voters defeated Initiative 2124.
As the political fight played out, lawmakers made more revisions. Some seemed to come in direct response to concerns raised by program critics. Almost all reflected recommendations of the Long Term Services and Supports Commission, the panel of legislators, agency representatives and community members tasked with monitoring and implementing the program.
A law passed in 2024 makes the benefit available for those who leave the state if they've paid into the fund during their career.
And a few weeks ago, Gov. Bob Ferguson signed Senate Bill 5291, which makes several notable alterations.
It allows workers to rescind their private insurance exemptions and opt in. The period to rescind exemptions starts Jan. 1, 2026 and ends July 1, 2028.
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State officials said they've heard from people who are interested because premiums for their policies have increased. Others said that the array of changes, such as making it possible to use benefits outside of Washington, made it worth joining.
The new law assures people who get out of the workforce for any period of time will resume building credit toward full eligibility when they return. It also provides automatic exemptions for active-duty military members with off-duty civilian work and non-immigrant visa holders.
And it opens a path for private insurers to create supplemental long-term care insurance policies designed for individuals with WA Cares benefits. This is expected to result in options for long-term care that are more affordable.
As envisioned, WA Cares benefits would cover the deductible of the private plan. So when an individual uses up their benefits, the supplemental private plan they purchase will kick in.
Private plans will need approval by the Office of the Insurance Commissioner.
There will be some requirements for the private plans. They must provide at least 12 months of coverage after WA Cares benefits are exhausted and allow people to keep their current care providers when transitioning between programs. The policies must also include options to reduce benefits rather than lose coverage if someone becomes unable to pay increased premiums, and they must cover care provided by qualified family members.
Finally, the new law clears the way to test the system for managing eligibility and paying providers. Up to 400 people in four counties — Thurston, Mason, Lewis and Spokane — are to be part of a pilot program that would run from Jan. 1, 2026 up until the formal launch.
There's much work to be done in the next 13 months. Veghte is convinced the payoff will be felt across the state.
Aging is a phase of life 'when we're all extremely vulnerable. I've seen it with both my parents how vulnerable you can become when you're frail and can't live independently,' he said. 'Having a pot of money the family can use to support that person in those times is a tremendous improvement in the quality of life for aging Washingtonians.'
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