Adult Family Homes Deserve at Least $350 Per Resident, Per Day. The state cannot demand around-the-clock care while reimbursing community providers at a fraction of the cost.
By Nathaniel Manny Ballantyne
Executive Director, Washington Association of Adult Family Home Providers (WAAFHA)
Key Figures (July 2026):
• $191.89/day: Washington’s July 2026 weighted-average AFH rate
• $375.08/day: Current nursing-facility swing-bed benchmark
Washington has made a policy choice that is becoming impossible to defend: it pays institutional nursing care at rates approaching $375 per day, while asking adult family homes to provide intimate, continuous, high-accountability care for far less. Adult family home providers are not asking for a windfall. They are asking the state to pay the actual cost of caring for the residents Washington entrusts to them.
A funding gap the state can no longer ignore
Washington’s June 2026 Medicaid notice set the weighted-average adult family home daily rate at $191.89 effective July 1, 2026. Providers also continue to identify rates near $138 per resident per day in individual payment situations and lower-acuity classifications. The $138 figure is therefore important to the lived experience of providers, but it should not be confused with the state’s current weighted average, because AFH rates vary by each resident’s assessed needs, program, add-ons and classification.
The nursing-facility comparison is equally important and must be stated carefully. Nursing-home Medicaid rates are facility-specific and cost-based; there is no single rate paid to every nursing home. But Washington’s current published swing-bed nursing-facility benchmark is $375.08 per day. The Legislature’s earlier fiscal-year 2025 estimate put the average weighted nursing-home Medicaid rate at approximately $364.67 per resident per day. These figures show the order of magnitude Washington recognizes for institutional care.
At $191.89, an AFH receives only about 51 percent of the $375.08 nursing-facility benchmark. At $138, the payment is only about 37 percent. Yet AFH residents do not stop needing help when the reimbursement runs out.
Twenty-four hours means twenty-four hours
An adult family home is not a hotel and an AFH provider is not merely renting a bedroom. Care must be available every hour of every day: midnight toileting, two-person transfers, dementia redirection, medication assistance, fall prevention, behavioral support, emergency response, repositioning, bathing, dressing, grooming, continence care, appointment coordination and communication with families, case managers and health professionals.
A resident may sleep for eight hours, but the provider cannot close for eight hours. Someone must remain responsible, alert and available. Staff must cover nights, weekends, holidays, vacations, illness and emergencies. Washington requires providers to maintain safe staffing and meet each resident’s assessed needs, but its rates too often assume that round-the-clock responsibility can be purchased at a part-time price.
The rate must also buy food, housing and a safe home
The daily payment must support far more than direct caregiver wages. Providers must purchase nutritious meals and snacks, accommodate therapeutic and culturally appropriate diets, pay utilities, heat and cool the home, maintain the building, insure the operation, replace equipment, manage records, train staff, meet licensing requirements, transport or coordinate transportation, and keep emergency supplies ready.
At $138 per day, the entire payment equals only $5.75 per hour when divided across 24 hours and that is before one dollar is spent on food, payroll taxes, relief staff, housing, insurance, training, transportation or compliance. Even at the verified weighted average of $191.89, the gross payment is about $8.00 per hour across the full day before operating expenses. No honest cost analysis can pretend that these numbers purchase continuous, sustainable care.
Why $350 per day is a minimum, not an extravagance
A minimum AFH Medicaid rate of $350 per resident per day would equal $127,750 per resident per year. That is substantial public funding because twenty-four-hour long-term care is substantial work. But $350 remains below Washington’s current $375.08 nursing-facility swing-bed benchmark, and it preserves the smaller, home-like setting many residents and families prefer.
The state should not interpret the lower overhead of an AFH as permission to underpay labor or ignore costs. AFHs may not operate institutional campuses, but they deliver highly personal care at close range. Their small scale is precisely what creates value: continuity, cultural familiarity, home-cooked meals, individualized attention and a stable household rather than an institutional corridor. Those benefits should be protected, not exploited.
Paying at least $350 would also strengthen Washington’s entire long-term-care system. Adequate rates would help providers recruit and retain caregivers, accept residents with complex needs, prevent avoidable hospital stays, support safe discharges and keep community placements open. Chronic underpayment produces the opposite result: burnout, turnover, delayed placements, closed beds and greater dependence on more expensive institutional care.
This is not a request for ‘more money’ it is a demand to pay the bill
AFH providers are not asking Washington to be generous. They are asking Washington to be honest. If the state requires safe staffing, twenty-four-hour availability, nutritious food, medication support, extensive documentation, ongoing training, regulatory compliance and individualized care, then the Medicaid rate must be built to purchase those things.
The state cannot write a care plan with one hand and underfund it with the other. It cannot promise vulnerable residents’ dignity and safety, then transfer the unpaid cost of that promise to small providers and low-wage caregivers. And it cannot celebrate home and community-based care while financing it at a level that threatens its survival.
Washington’s obligation
The Governor and Legislature should enact a statutory minimum AFH Medicaid rate of at least $350 per resident per day, with higher acuity-based add-ons, annual inflation adjustments and transparent cost studies. The state should also ensure that room-and-board policy and resident participation rules do not leave providers carrying expenses that the payment system refuses to recognize.
The principle is simple: when Washington places a resident in an adult family home, Washington must pay the cost of the care it requires. Anything less is not savings. It is a hidden debt imposed on caregivers, providers and vulnerable residents. Washington’s adult family homes have carried that debt long enough.