2027 Medicaid Changes: What Washington Seniors Need to Know

If you’re helping a parent or spouse plan for assisted living, memory care, or an adult family home, here are the Medicaid changes worth knowing.

Most of the new Medicaid work and renewal requirements do not apply to adults over 65 receiving traditional Medicaid. The widely discussed work requirements and six-month eligibility renewals generally apply to working-age adults.

A few changes may matter if your loved one needs Medicaid-funded long-term care.

1. Applying for Medicaid? Timing will matter more in 2027.

Starting January 1, 2027, Medicaid will generally cover eligible medical expenses for up to two months before the application month, instead of three, for older adults using traditional Medicaid.

For an April application, eligible expenses could be covered from February rather than January.

April application: retroactive medical coverage

For eligible medical expenses only; eligibility must be met in each month. This does not automatically cover assisted living or adult family home services before they are authorized.

2. Own a home? A stricter equity limit is coming in 2028.

Washington’s 2026 home equity limit for certain Medicaid long-term care services is $1,130,000. Beginning January 1, 2028, the federal maximum is scheduled to decrease to $1,000,000.

The 2027 limit may be adjusted for inflation before the new cap takes effect.

Home equity is not the same as home value. It’s the value of the home minus the mortgage balance. For example, a home worth $1.2 million with a $150,000 mortgage has $1,050,000 in equity. That would fall below the 2026 limit but exceed the scheduled 2028 limit.

Important exceptions apply, including when a spouse or certain dependent children live in the home. The scheduled federal cap also includes an exception for homes on land zoned for agricultural use. Eligibility depends on the person’s ownership interest and other rules.

3. Moving from private pay to Medicaid? Ask about provider policies.

Not every adult family home or assisted living community accepts Medicaid. Providers that do may have different admission and private-pay transition policies.

For eligible residents, Medicaid can cover authorized care services in contracted adult family homes and assisted living. Residents generally contribute toward room and board from their income and may also contribute toward care costs.

Washington is scheduled to update Medicaid assisted living reimbursement rates beginning July 1, 2027. The scheduled rebase does not tell us whether Medicaid admissions or availability will increase or decrease; the financial impact is not yet known.

For more background, read Opportunities and Caveats When Transitioning to Medicaid.

4. Married? A 2027 deadline may affect spousal protections.

A federal requirement to apply spousal income and asset protections to certain home and community-based Medicaid programs runs through September 30, 2027, unless Congress extends it.

This deadline does not end all Medicaid protections for married couples. Separate rules protect spouses in other situations, and Congress has extended this requirement before.

What about the new Medicaid work requirements?

If your loved one is 65 or older and receiving traditional Medicaid, the new 80-hour monthly work requirements and six-month renewal rules generally do not apply.

These changes primarily affect adults ages 19 through 64 enrolled in Medicaid expansion.

Planning ahead can help avoid difficult decisions

For most older adults, these changes do not require immediate action. Planning ahead can still help avoid difficult care decisions.

If Medicaid may be needed, review eligibility, care costs, and provider policies before moving.

Silver Age Senior Living Advisors helps families in greater Seattle compare adult family homes, assisted living, and memory care, including how care needs and finances may change.

The right care choice should work today and in the future.

For more context, read Why Senior Living Options May Get Tighter in Washington.

Last reviewed: October 2026. Medicaid rules and implementation details may change. This article provides general information and is not legal or financial advice.