With private long-term care coverage shrinking and Medicaid requiring near-total impoverishment to qualify, states have started building their own. Washington's WA Cares — the first universal public long-term care benefit in America — began paying out in July 2026. It's modest, it's mandatory, and it may be the clearest signal yet of where this whole market is heading.
Enacted in 2019 and funded by a 0.58% payroll tax collected since July 2023, WA Cares pays a lifetime benefit of up to $36,500 (adjusted for inflation) for long-term care services — professional care, home safety equipment, even paying a family member to provide care. You qualify by contributing for about 10 years (with faster pathways: three of the last six years earns the full benefit, and those born before 1968 can get prorated benefits), and by needing help with at least three activities of daily living.
The program is on solid footing — it accumulated more than $1 billion in reserves in its first year and projects as solvent over a 75-year horizon. And in 2024, Washington voters rejected Initiative 2124, which would have made participation voluntary, by about 55.5% — a decisive vote to keep the program mandatory, since letting people opt out would have collapsed the risk pool.
The honest read on WA Cares is that it's a genuine, if limited, safety net. $36,500 covers roughly four months of facility care; it will matter enormously to a middle-income family with no other coverage, and not much to a long dementia claim. Its real significance is as a proof of concept — the first evidence that a state can run public long-term care insurance without it collapsing.
There's a wrinkle worth naming. When the tax loomed, Washington offered a window to opt out by buying private LTC insurance before a November 2021 deadline — and roughly 450,000 residents did exactly that, handing the private industry a sudden surge of new policies. The public program's arrival, in other words, became a sales engine for the very private market it was meant to backstop.
New York has a proposed Long-Term Care Trust Program modeled on WA Cares that could take effect as soon as 2027 — and, importantly, any opt-out via private insurance would likely require coverage in force before the program's start, so residents watching this need to act early. California has completed feasibility studies; its proposed payroll tax could run from about 0.6% up to 3% at the richest benefit design, with a possible income cap. Massachusetts and several other states are exploring their own versions.
For everyone not covered by a state program or private insurance, the real backstop remains Medicaid — but only after spending down nearly all your assets. That's the status quo these programs are trying to change: a system where the default way to pay for care is to go broke first.
None of the tri-state corridor has a WA Cares-style program yet — Massachusetts is among the states studying one, while Vermont and New Hampshire have not enacted a public benefit. For now, families here rely on private coverage, personal savings, or the Medicaid spend-down, in a region where care costs run well above the national median. If the WA Cares model spreads east, this is a story worth watching closely.
The bottom line: if you live in Washington, WA Cares is a real benefit you're already paying for — know how to claim it, but don't mistake $36,500 for a long-term care plan. If you're in a state considering one, watch the opt-out deadlines, because the decision to buy private coverage may be time-limited. And everywhere else, the lesson of the state-program movement is the same one the private market's collapse taught: long-term care is the great unfunded risk of American retirement, and hoping to sort it out later is how families end up spending down to Medicaid.