Washington Medicaid Personal Care (MPC) Program

Page Reviewed / Updated - Mar. 2014

Waiver Description

The MPC Program provides elderly and disabled Washington residents with personal care services. Services are provided to individuals that reside in their homes or in adult family homes including residential communities such as assisted living, but not in nursing homes.

The MPC program is based on the Cash and Counseling model in which the participating individual has the flexibility to self-direct their care. This is also referred to as the Consumer Direction Option, CDO or Participant Direction.  Program participants are able to select their own personal care providers and act as the employer of that individual; the employee is referred to as an Individual Provider or IP. In Washington, participants can choose a home care agency or select a friend, neighbor or family member to be their IP. In other words, family members can be paid to be caregivers. This includes the adult children of aging parents, but does not include spouses. If a non-professional caregiver is selected, they are subject to a background check by the state and if approved they join the Service Employees International Union (SEIU) Local 775.  Payments are made to the care providers by authorization from the program participant’s Case Manager.

 MPC does not pay for room and board.

Under MPC, individuals may choose to live in assisted living communities or adult foster care instead of in their own homes.  Persons doing so are responsible for paying their own room and board fees.  These are not covered services. 

 

Eligibility Guidelines

There are both financial and functional qualifiers for the MPC program. Functionally, participants must have a need for assistance with the at least 3 of the following activities of daily living.

  • Bathing
  • Bed Mobility
  • Dressing
  • Eating
  • Medication Management
  • Mobility Around and Outside the Home
  • Personal Hygiene
  • Toileting
  • Transfer

Financially, they must be eligible for Washington's Non-institutional, Categorically Needy Medicaid program which has different limits from standard Medicaid. In 2014, this limit is $721 / month but for certain persons could be as high as $2,163. The latest information is published on the Washington Social and Health Services webpage.

There is also an asset or "countable resource" limit of $2,000 or $3,000 for an individual and married couple, respectively. However, if one spouse is not applying for Medicaid, the asset limit goes up to $117,240. One's home is consider exempt unless the real estate value of the home is in excess of $543,000.

Washington Medicaid's financial eligibility is especially complicated and for the MPC program even more so. For married couples with one spouse applying, it becomes even more complex. It is critical to structure one's finances so that the non-applicant spouse maintains sufficient monetary assets on which to subsist. For this reason, we suggest couples in this situation consult with either a public benefits counselor or a private financial planner to help them prepare for a Medicaid financial review.  Read more

 

Benefits and Services

Program participants are eligible to receive assistance with personal care services. This refers to human assistance with the activities of daily living such as bathing, eating, toileting, mobility, grooming and personal hygiene. Unlike many states, Washington Medicaid’s Personal Care Program does not require individuals to live at home. Instead individuals that reside in adult residential communities, such as assisted living, can also receive personal care services. However, this program does not include individuals that reside in nursing homes.

 

How to Apply / Learn More

Individuals already enrolled in Medicaid should talk with their Case Manager about participating in the MPC program. For those not enrolled in Medicaid, they can begin the process on Washington’s Medicaid webpage. Alternatively, they can call 1-800-562-3022 or visit this link.

A very important distinction about this program is that it is an entitlement program. Most Medicaid programs that provide for care services outside of nursing homes are not entitlement programs including COPES and the Medically Needy In-Home and Residential Waivers. The important of this cannot be overstated. If you qualify, then services will be provided. There are no waiting lists.

 Washington also offers a self-directed Medicaid program called COPES which covers a wider range of services including home modifications to help aging in place.  Learn more.