A week before WA Cares benefits are scheduled to become available, the state’s Long-Term Services and Supports Trust Commission discussed program launch, early applications and provider readiness needs. I brought up the still-confusing experience facing potential family caregivers and would-be beneficiaries who want access to the limited benefit they’ve been paying payroll taxes to earn for the past three years.
The June 24 meeting had some encouraging moments. State officials described an application process that is moving faster than the 45 days allowed under statute. The median number of days between contribution determination and eligibility was eight days. Of course, the number of applications will increase, as only a small number of Washingtonians have met contribution requirements and have health needs just three years in. For most people paying the payroll tax, program eligibility won’t happen for another seven or more years. Still, Alena Tourtellotte, who directs data analytics for WA Cares at the Department of Social and Health Services, said the turnaround timeline so far was promising.
Also encouraging, all applicants who met the program’s contribution requirement and then completed a health assessment were approved based on their need for help with activities of daily living. That matters. WA Cares is supposed to help people with long-term care needs, not bury them under paperwork until the paperwork qualifies for care.
The meeting also revealed a serious problem, however: Many people applying for benefits were not eligible because they had not yet met the program’s contribution requirements. To be eligible as early as July, a person has to have paid the WA Cares payroll tax for the past three years for at least 500 hours each year. The website could make that more clear. Right now, it appears the detail about 500 hours is missing from a key explanation webpage. That could be part of the problem. (After meeting the contribution requirement, applicants are then given a health assessment. See more here.)
As of Monday, Tourtellotte reported, 113 people had applied, but only 44 were eligible for program benefits. “So we are seeing about a 50% denial rate,” she said. My math shows a 61% denial rate based on those numbers and a slide that was presented titled, “Applicants and Beneficiaries,” but I trust Tourtellotte has more details and can justify the 50%. Answers about the discrepancy had not been returned at the time this was written.
Whether the denial rate is 50% or 61%, the number of denials is concerning — especially as WA Cares is expecting 25,000 enrollees even in the program’s first fiscal year. Commissioners rightly made it an action item to follow up on the need for clearer eligibility information before even more people spend time applying for a benefit they cannot yet receive, bringing applicant frustration and unnecessary administrative work.
Important information for family providers is still MIA
During the meeting’s public comment time, I told them my concern about family caregivers not having clear information or guidance about how to become a paid family caregiver through WA Cares, which we have been told is a major reason for WA Cares. Supporters have long promoted the idea that eligible beneficiaries can use their benefit to pay a family caregiver. That feature matters. Family caregivers could help address provider shortages, especially in areas of the state where formal long-term care services are limited. Commission members Wednesday heard about provider adequacy for WA Cares. There are gaps in available services and concerns about adult family homes, adult day services and access in rural areas.
Family caregiving should be part of the answer to those problems. So why does becoming a paid family caregiver remain hard to understand and funneled toward a unionized employer? I have raised this concern for months in writing, with WA Cares staff and during WA Cares webinars. The more I learn, the less accidental the confusion looks.
Current public materials point family caregivers toward becoming individual providers employed through Consumer Direct Care Network Washington (CDWA), which is linked to Service Employees International Union 775. Caregivers employed by CDWA are represented by SEIU 775, and the CDWA-SEIU agreement has treated union membership or equivalent financial obligations — such as dues or fees — as a condition of continued employment.
Guiding family members who already care for mom or a spouse to become unionized employees of CDWA, which requires various payments, will likely be putting a dent in the already limited $36,500 that should be going to beneficiaries with LTC needs, not diverted to satisfy union or employer structures that families may not want, need or benefit from.
Another employment path through home care agencies is available to family caregivers, but that option is not explained with the same clarity or prominence, and easy links are not offered. Further, commission materials just last year discussed a third option that would have emphasized beneficiary choice, minimal interference in the family-caregiving relationship, worker protections and maximizing the limited benefit. I have learned this oft-discussed solution is no longer being pursued, even though those of us watching the WA Cares sausage get made were led to believe it was on the way.
Clearer, easy-to-find information about options and obligations is needed from WA Cares pronto.
What a family caregiver chooses affects more than scheduling and paperwork. Caregivers need to know union membership or dues obligations, training requirements, health or retirement trust contributions and any other benefit-related costs. They also need to know whether they will actually qualify for or use any advertised benefits intended for professional caregivers with SEIU, especially if they already have health coverage or provide care only part time or temporarily after a family member’s injury or illness.
Beneficiaries also need to understand how much of their limited WA Cares benefit will go to the family caregiver’s hourly pay, how much will go to an employer or other entity, and if routing care through an employer structure reduces the amount available for actual care, home modifications, equipment or other covered supports.
A speaker who offered public comment after me agreed that family caregiver information needs to be clearer, and by the end of the meeting, commissioners identified caregiver clarity and transparency as an action item.
That is welcome. It is also late. People are applying for WA Cares now, and benefit payouts are about to begin.
WA Cares is about to move from theory to people’s lives. The next commission meeting is not scheduled until September, after benefits have launched. By then, families could already be trying to navigate a system that tells them family caregiving is allowed but does not clearly explain how to do it, what it costs, what choices exist or how much of the benefit will actually reach the caregiver.
WA Cares administrators and commissioners, who are aware of the problem, should fix this communication problem now. The state should not wait for confusion to become a known launch feature.
