Washington is a relatively small northwestern state with 5.8 million people in 1999, about 11.5 percent of whom were age 65 and over. The state is doing well economically and only about 8.9 percent of the population lives in poverty, well below the national average. Washington provides home and community services to a very substantial number of beneficiaries through the Medicaid personal care program, a large Medicaid home and community-based services waiver, and some small and shrinking state-funded programs. Washington has a national reputation as a leader in innovative home and community services and relies heavily on consumer-directed home care and nonmedical residential services, such as assisted living and adult family homes.
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