Washington Medicaid Rate Estimator

What Is the Medicaid Rate Estimator?

It's a free online tool that walks you through the key factors that determine a resident's CARE classification: the activities they need help with, their cognitive function, any medical conditions or treatments, and their behavioral health needs.

The estimate is based on the publicly available criteria from the Washington Administrative Code (WAC 388-106) and the DSHS County Rates Tool. It takes about 3-5 minutes to complete and requires no sign-up or personal information.

What You'll Get

• Estimated daily rate — the base DSHS payment for the resident's CARE classification in your county
• Community Integration (CI) add-on — shows if the resident qualifies for the ~$5/day CI add-on
• Monthly and annual projections — estimated monthly and yearly totals based on the daily rate
• Printable PDF report — a downloadable summary you can keep for your records

Who It's For

• AFH providers — estimate payment rates for prospective residents before they move in
• Families — understand what Medicaid will pay toward care costs
• Discharge planners — quickly check if a patient's care needs align with available rates
• Case managers — get a preliminary estimate before the official CARE assessment

How It Works

1. Select a county — rates vary by county across Washington's 39 counties
2. Answer questions — about ADLs, cognition, medical complexity, and behavior
3. Get your estimate — instant daily rate with classification and breakdown

What Is a CARE Classification?

The Comprehensive Assessment Reporting Evaluation (CARE) is DSHS's tool for assessing long-term care needs. It measures cognitive performance, clinical complexity, mood and behaviors, activities of daily living (ADLs), and exceptional care needs to place individuals into one of 17 residential classification groups.

These groups range from A Low (lower care needs) to E High (exceptional care needs). Each classification has a corresponding daily payment rate that varies by county.

Classification Groups

• Group A — Lower care needs, minimal assistance
• Group B — Behavioral health needs (mood/behavior criteria met)
• Group C — Clinically complex, mild cognitive impairment
• Group D — Clinically complex, significant cognitive impairment
• Group E — Exceptional care needs (ventilator, trach, etc.)

Each group has sub-levels: Low, Medium, Medium-High, and High — determined by the resident's ADL score.