Most King County adult family homes hold a DSHS Medicaid contract; most assisted living does not. Here is how Apple Health, COPES and the dementia program work, and how to check a specific home.
By Diane Whitfield, CSA · October 24, 2026
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Listen to this guide as a 6-minute podcast episode, or read on. Hosts Marcus and Dana are AI-generated voices.
Marcus: Welcome to the Seattle Senior Advisor podcast. I'm Marcus.
Dana: And I'm Dana. Today's question is one we hear every week: which care homes around Seattle actually take Medicaid?
Marcus: Because the money runs out. Mom's been paying privately, or she never had much to begin with, and now the family needs a place that takes Apple Health.
Dana: Right. Apple Health is Washington's name for Medicaid. And for long-term care it usually works with the COPES waiver, which can pay for care in adult family homes, adult residential care facilities and assisted living.
Marcus: So let's start there. Which Seattle-area care homes accept Medicaid?
Dana: Mostly adult family homes. We looked at the state's licensing data from October 24, 2026. In King County, 1,681 of the 1,825 operating adult family homes held a DSHS contract. That's 92 percent.
Marcus: And assisted living?
Dana: Very different. Only 56 of King County's 153 assisted living facilities were marked by DSHS as able to accept Medicaid. That's 37 percent.
Marcus: So if I tour five assisted living buildings, three of them might not take Apple Health at all.
Dana: That's the math. So ask before you tour. And it's the same pattern next door. Pierce County had 1,035 contracted adult family homes out of 1,084, and Snohomish had 1,132 out of 1,186.
Marcus: Quick reminder for anyone new: an adult family home is a licensed private home for up to six residents, and assisted living is seven or more.
Dana: Exactly. And a lot of families never consider adult family homes until they see these numbers.
Marcus: Here's one people search all the time. Medicare versus Medicaid. Which one pays for an adult family home or assisted living?
Dana: Medicaid can. Medicare doesn't. Medicare's own coverage page says it does not provide long-term care or custodial care unless medical care is needed.
Marcus: And help with bathing, dressing and medications counts as custodial care.
Dana: That's exactly what it is. Medicare still pays for hospital stays, doctor visits, prescriptions and a limited rehab stay after a hospitalization. But when rehab ends, someone has to pay for the daily care.
Marcus: So a "Medicare-accepted adult family home" isn't really a thing.
Dana: Not for the long-term stay. What you're really looking for is a home that takes Apple Health, or a plan to pay privately.
Marcus: What about memory care? How do you find Medicaid memory care in Seattle?
Dana: Two places to look. Dementia-capable adult family homes, and assisted living facilities with a contract for the Specialized Dementia Care Program. In King County, only 17 assisted living facilities had that contract in the October data.
Marcus: Seventeen. Out of 153.
Dana: Out of 153. So the adult family home route is often faster. In King County, 1,654 of the contracted adult family homes also list a dementia specialty.
Marcus: What does the dementia program require?
Dana: Three things. A diagnosis of Alzheimer's or another irreversible dementia. Receiving or being eligible for Medicaid. And a DSHS case manager's assessment showing a need for specialized dementia care. It includes awake staff 24 hours a day and dementia-specific training. But DSHS says space has to be available and funding is limited.
Marcus: And the new memory care certification? Is that the same thing?
Dana: No, and this trips people up. Certification is about care standards, not payment. Of 88 King County assisted living facilities flagged as memory care certified, only 22 were also marked able to accept Medicaid.
Marcus: Okay, money. Who qualifies for Apple Health long-term care in 2026?
Dana: For a single person, income up to $2,982 a month and countable resources of $2,000 or less, plus a functional need confirmed by a DSHS assessment.
Marcus: Two thousand dollars. That scares people.
Dana: It does, but a lot isn't counted. The home, a car, an irrevocable burial fund and household goods. And higher income can still qualify. Your parent just pays more toward care.
Marcus: So if Mom moves into an adult family home on Apple Health, what does she keep?
Dana: A personal needs allowance of $108.74 a month. The rest of her income goes toward her care, room and board, and Apple Health pays the remaining care cost. It doesn't pay room and board.
Marcus: Last one. How do you check whether a specific Seattle home takes Medicaid?
Dana: Look it up on the DSHS provider lookup. For assisted living, the results say whether the facility can or cannot accept Medicaid. For an adult family home, look at its contracts. "No Contract" means private pay only.
Marcus: And then call.
Dana: Then ask three questions in writing. Do you accept residents on Apple Health at move-in? If Mom starts private-pay, will you keep her when the money runs out? And is a Medicaid bed open right now?
Marcus: And if you don't know where to start?
Dana: Washington's Community Living Connections line, 1-855-567-0252, can route you to local long-term care help, and you can apply online at Washington Connection.
Marcus: The full guide, with the comparison table and the DSHS numbers, is in the description.
Dana: And if you'd like help finding a home that takes Apple Health, a Seattle Senior Advisor is free. See you next time.
Most adult family homes in King County do, and most assisted living facilities do not. In the October 24, 2026 export of Washington DSHS's Residential Care Services lookup, 1,681 of King County's 1,825 operating adult family homes (92%) held a DSHS contract, while only 56 of its 153 assisted living facilities (37%) were marked by DSHS as able to accept Medicaid.
That gap is the single most useful fact for a family whose parent will run out of money, or already has. Washington's Medicaid program is called Apple Health, and for long-term care it is usually paired with the COPES waiver, which pays for care in adult family homes, adult residential care facilities and assisted living facilities. If your parent may need Apple Health within a year or two, start the search where the contracts are.
| Setting (King County, operating) | Licensed | Medicaid contract or "can accept Medicaid" | What it means for families |
|---|---|---|---|
| Adult family homes (up to 6 residents) | 1,825 | 1,681 (92%) | Widest Medicaid access; 1,654 of those also list a dementia specialty |
| Assisted living facilities (7+ residents) | 153 | 56 (37%) | Most are private-pay only; ask before you tour |
| Assisted living with a Specialized Dementia Care Program contract | 153 | 17 (11%) | The Medicaid memory care option; space is limited |
| Assisted living certified for memory care | 153 | 22 of 88 also accept Medicaid | Certification is about care standards, not payment |
The pattern holds next door. Pierce County had 1,035 contracted adult family homes out of 1,084 and 41 Medicaid-accepting assisted living facilities out of 58. Snohomish County had 1,132 of 1,186 and 22 of 48. You can browse licensed homes by city in our Seattle adult family home directory.
Medicaid can; Medicare does not. Medicare's own coverage page says it "does not provide long-term care coverage or custodial care unless medical care is needed," and that Medicare and Medigap do not pay for long-term care services in a nursing home or in the community. Help with bathing, dressing, meals and medications in an adult family home or assisted living is exactly that kind of care.
Medicare still matters around the edges: it pays for hospital stays, doctor visits, prescriptions and a limited skilled-nursing rehab stay after a hospitalization. When that rehab ends, the question becomes who pays for ongoing daily care, which we cover in what happens after Medicare's rehab days. So a search for a "Medicare-accepted adult family home" is really a search for a home that accepts Apple Health, or a plan to pay privately.
Look at two places: dementia-capable adult family homes, and the small number of assisted living facilities with a Specialized Dementia Care Program (SDCP) contract. In King County that program was available in 17 assisted living facilities in the October 2026 DSHS data, so the adult family home route is often the faster one.
DSHS describes SDCP as a program for a person with dementia who can no longer live at home. All three conditions apply: a diagnosis of Alzheimer's disease or another irreversible dementia; receiving or being eligible for Medicaid; and an assessment by a DSHS case manager finding a need for specialized dementia care. The package includes awake staff 24 hours a day and dementia-specific staff training. DSHS says it contracts with a small number of facilities, space must be available, and funding is limited.
Washington's new memory care certification is a separate thing: it sets care standards, not payment. Of the 88 King County assisted living facilities flagged as memory care certified, only 22 were also marked able to accept Medicaid. Our guide to Washington's memory care certification explains what to ask.
For a single person, income up to $2,982 a month and countable resources of $2,000 or less, plus a functional need confirmed by a DSHS assessment. The $2,982 figure is the Medicaid Special Income Level in effect January 1, 2026, which is 300% of the $994 SSI rate, per the Health Care Authority's income standards.
WashingtonLawHelp's COPES guide (reviewed October 23, 2026) adds the details families ask about. Higher income can still qualify, but the person pays more toward care. The home, a car, an irrevocable burial fund and household goods are not counted. In an adult family home or assisted living, the resident keeps a personal needs allowance of $108.74 a month, and the rest of their income goes toward care, room and board. Apple Health pays the remainder of the care cost, not the room and board.
Apply online at Washington Connection or through a local DSHS office. If you are not sure where to start, Washington's Community Living Connections line, 1-855-567-0252, routes you to local long-term care help. Our COPES waiver guide walks through the assessment.
Look the home up on the DSHS provider lookup, then ask the home directly before you tour. For assisted living, the DSHS results page states whether a facility can or cannot accept Medicaid. For adult family homes, the record lists the home's DSHS contracts; "No Contract" means private pay only.
A contract tells you the home can bill DSHS. It does not tell you whether a bed is open today, or whether the home will admit someone who is already on Apple Health versus only allowing a private-pay resident to convert later. Ask three questions in writing: Do you accept residents on Apple Health at move-in? If my parent starts private-pay, will you keep them when the money runs out? Is a Medicaid bed open now? Our guide to the private-pay to Apple Health transition covers the second question in depth.
Last verified: October 2026. Counts come from the Washington DSHS Residential Care Services lookup export dated October 24, 2026; they change as homes open, close and sign contracts.
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