Washington State is the first state in the nation to create a publicly funded insurance program providing residents with a basic level of long-term care benefits.
Participation is mandated unless an employee opts out, which must happen before November 1, 2021.
An overview of the program and its potential impact on individuals and businesses follows.
Long-Term Services and Supports (LTSS) Program Details
There were many motivating factors when Governor Jay Inslee signed the Washington Long-Term Services and Supports (LTSS) Trust Act and established the LTSS Trust Program and Commission in May 2019, including:
- Private long-term care insurance is expensive and isn’t covered by Medicare or other health insurance plans.
- The majority of individuals over 65 years old require long-term care services, and viability for family caregivers is decreasing.
- The program provides relief to Medicaid.
How Is the LTSS Program Funded?
The program will be fully funded by Washington workers through a payroll deduction starting in January 2022.
Beginning January 1, 2022, a 0.58% mandatory payroll premium will be assessed against all W-2 wages uncapped. Rates can change and will be assessed biannually.
How Can Individuals Qualify for LTSS Benefits?
Revised Code of Washington (RCW) 48.83.020 defines long-term care for the state of Washington and includes the following:
- Long-term care riders on life insurance and annuities
- Qualified long-term care contracts
- Long-term care riders or policies purchased under group coverage
Washington residents will be considered vested if they’ve:
- Paid premium for at least 10 years without a break of five consecutive years or for three of the last six years
- Worked at least 500 hours per year in each of the qualifying years
Individuals qualify to receive benefits if they’re unable to perform three of 10 Activities of Daily Living (ADLs) without assistance.
Benefits will be available beginning January 1, 2025. Benefits aren’t portable; individuals who leave Washington forfeit their benefits.
How Are Benefits Determined for LTSS Participants?
Participants receive benefits as reimbursements of approved services rendered.
Each vested participant is allotted 365 benefit units. Each unit is worth $100, and participants can use one benefit unit per day. The resulting total benefit pool available is $36,500.