Washington Medicaid Personal Care (MPC) Program

Program Description

As of summer 2015, Medicaid Personal Care has largely been replaced by the Community First Choice Option program. However, some persons will be eligible for Medicaid Personal Care who are not eligible for Washington's Community First Choice.

The Medicaid Personal Care (MPC) Program provides low-income 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 select who is their caregiver. This is also referred to as the Consumer Direction Option, CDO or Participant Direction. Program participants are able to pick 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 must 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 family homes instead of in their own homes. In either case, participants are responsible for paying their own room and board fees, as these expenses are not covered. 

 

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
  • Transferring (standing from a chair or a bed) 

Financially, seniors (aged 65 or over) must be eligible for Washington's Non-institutional, Categorically Needy Medicaid program. These program rules are stricter than classic Medicaid. In 2018, this limit is $750 per month for a single applicant and $1,125 for a married couple in which both spouses applying for benefits. Certain deductions for health insurance premiums are permitted from the applicant's income. Persons with income over this monthly income limit should consider applying to the Community First Choice Option program for long-term care supports outside of a nursing home.

There is also an asset, or "countable resource," limit of $2,000 or $3,000 for an individual and married couple, respectively. There are no financial protections for a spouse when their husband or wife needs more care. One's home is considered exempt, given the applicant or their spouse lives in it and it is not valued at more than $572,000, but a second home or property, is not exempt. Other exemptions include personal effects, household items, a vehicle, and pre-arranged burial plans.

For those who are unsure whether they are eligible for the MPC program, we suggest they consult with either a public benefits counselor, elder law attorney, 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. Nursing services are also available, such as nursing assessments, care coordination, and skilled treatment. 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 of applying for Washington’s Medicaid by calling their local Home and Community Services office or applying online at this link. Finally, applicants are also allowed to complete the paper application, but the online application is processed quicker. To learn more about the MPC program, click here.

Most Medicaid programs that provide for care services outside of nursing homes are not entitlement programs. In Washington State, this includes COPES and the Medically Needy In-Home and Residential Waivers. A very important distinction about this program is that it is an entitlement program.  The importance of this cannot be overstated. If you qualify, then services must 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.