What It Costs to Live in an Adult Family Home, by City and County

The DSHS daily rate is what the state pays the home. A Medicaid resident contributes most of their own monthly income toward that cost and keeps a small personal needs allowance. So a family's out-of-pocket under Medicaid is usually the resident's income, not the rate shown here; the rate matters because it is what makes a home willing to accept a Medicaid placement at a given care level.

DSHS pays a 'High Cost' schedule in those three counties and a 'Standard Cost' schedule everywhere else. Within a region the base rate depends on the resident's CARE classification (A Low through E High), which a DSHS case manager assigns after an assessment; some residents also qualify for add-on payments for specialized services, which are not included in the figures here.

There is no public dataset of private-pay AFH rates in Washington. The ranges shown are working bands from David Stein's brokerage and appraisal experience with operating homes, reviewed on the date shown, and they are per resident per month, not the home's total revenue. Individual homes quote their own rates, and memory care or heavy-care needs sit above the top of any band.

King County has the widest private-pay spread in the state. South King (Kent, Federal Way, Renton, Auburn) sits below the county average, the Eastside (Bellevue, Kirkland, Redmond, Issaquah, Bothell) sits above it, and Mercer Island, Medina, and Clyde Hill are a premium market of their own. Typing a city shows its submarket; typing 'King' shows the countywide band.

On average, yes, but the spread inside a county is wider than the spread between counties. Care level, private room versus shared, and whether the home has a nurse on staff move the number more than the ZIP code does. Use the county figure to set a budget, then compare specific homes.