In 2019 the Long-Term Services and Supports (LTSS) Trust Program (Trust Program) was enacted to provide long-term services and supports benefits to persons who have paid into the Trust Program for a specific amount of time and who have been assessed as needing a certain amount of assistance with activities of daily living (ADL).
Beginning July 1, 2023, a premium of 0.58 percent began being assessed on the wages of all employees in Washington who have worked at least 500 hours during the year. A Washington resident who is at least 18 years old and who has paid the premium for either: (1) a total of ten years without interruption of five or more consecutive years; or (2) three years within the last six years from the date of application for benefits is deemed qualified individual status.
A qualified individual may become an eligible beneficiary upon having been assessed as requiring assistance with at least three ADLs. Eligible beneficiaries must be at least 18 years old, must be a Washington resident, and may not have been disabled before the age of 18. Beginning July 1, 2026, (1) a qualified individual may become an eligible beneficiary by filing an application with the Department of Social and Health Services (DSHS) and undergoing an eligibility determination; and (2) approved services must be available and benefits payable to a registered long-term services and supports provider on behalf of an eligible beneficiary.
Benefit units are currently $100 and may be adjusted by the LTSS Council at a rate no greater than the adjustment to the consumer price index (CPI). An eligible beneficiary may not receive more than the dollar equivalent of 365 benefit units over the course of the eligible beneficiary's lifetime or $36,500?$100 benefit units x 365 days.
Persons who are self-insured may elect coverage under the Trust Program and may withdraw from coverage according to time frames established by the Employment Security Department (ESD). Certain individuals were eligible for a voluntary exemption from the Trust Program.
The Trust Program is administered jointly by DSHS, ESD, and the Health Care Authority. Trust Program oversight is provided by the LTSS Commission (Commission) which includes legislators, agency directors, and representatives from area agencies on aging, stakeholders, and consumers of approved services. The Commission has provided reports to the Legislature with recommendations in 2021, 2022, 2023, and 2024.
Out-of-State Participation in Long Term Services and Support Program?Portability. Beginning July 1, 2026, an employee or self-employed person who has left Washington may elect to continue participating in the Trust Program if they:
Out-of-state participants must report and document their wages or earnings to ESD and pay premiums. Once an out-of-state participant reaches age 67, they are no longer required to document earnings but must submit reports and remit premiums. ESD may cancel coverage if a participant fails to make payments or submit reports with 30 days' notice. ESD must adopt standards for the manner and timing of reporting and document submission for out-of-state participants, collect premiums from out-of-state participants, and verify the wages or self-employment earnings reported by out-of-state participants. The act provides that extending the premium base to out-of-state participants will increase the state's investment in long-term care services.
An employee or self-employed person who relocates outside of Washington may elect to opt out of coverage by no longer reporting wages to ESD, rather than become an out-of-state participant in the program.
Benefits for Out-of-State Participants. For out-of-state participants, benefits are available beginning July 1, 2030. For an out-of-state qualified individual to become an eligible beneficiary beginning July 1, 2030, the individual either: (1) is unable to perform, without substantial assistance from another individual, at least two of the following ADLs for a period of at least 90 days due to a loss of functional capacity: eating, toileting, transferring, bathing, dressing, or continence, or (2) requires substantial supervision to protect such individual from threats to health and safety due to severe cognitive impairments.
Entities that provide services to out-of-state participants must meet care provision and program administration standards established by DSHS and be appropriately credentialed in the jurisdiction in which the services are being provided. DSHS must develop criteria to deem a family member as qualified when providing services outside of Washington.
Prohibition on Discrimination. Discrimination against persons based upon race, gender, age, or preexisting condition is prohibited under the Trust Program. DSHS must adopt rules to prohibit discrimination in the Trust Program to apply to all state agencies, persons, and entities implementing the chapter. These prohibitions apply to both in-state and out-of-state participants as well as entities providing services to eligible beneficiaries outside Washington. The prohibitions are additional and supplemental to existing protections against discrimination under federal, state, and local laws.
The act's purpose is provided.