Washington Medicaid Alternative Care Program: Eligibility & Benefits

Program Description

The Washington Medicaid Alternative Care (MAC) Program is provides supportive services to unpaid primary caregivers of elderly Washington residents. The MAC Program is intended to assist the caregiver, help prevent burnout, as well as prevent premature nursing home placements. It does so, by helping senior care recipients continue to live in their homes or the homes of a relative. Examples of available benefits include adult day care, durable medical equipment, respite care, personal emergency response systems, and more.

MAC is under the umbrella of the Medicaid Transformation Project Demonstration, and it may be called, informally, the Family Caregiver Support Program. That said, there is a very similar program to MAC also under the Medicaid Transformation Project Demonstration called the Tailored Support for Older Adults (TSOA) Program. Unlike MAC, which is for seniors who are eligible for Medicaid, TSOA is for the elderly who do not qualify financially for Medicaid. However, the services and benefits available through both programs are very similar.

 

Eligibility Guidelines

In order to be eligible for this program, there are, age, living arrangement, functional, and financial requirements. There are eligibility criteria that apply to both care recipient and their caregiver.

Caregiver Requirements

  • Must be no younger than 18 years of age.
  • Must be providing care to the care recipient as their primary caregiver and they cannot be receiving compensation for their caregiving efforts.

Care Recipient Requirements

  • Must be at least 55 years old.
  • Must live in a home setting, such as their home or the home of a friend or relative. Applicants who live in assisted living residences will not qualify.
  • Must need a level of care consistent to that which is provided in a nursing home. In addition, the care receiver must require assistance with some Activities of Daily Living (ADL’s), such as bathing, grooming, dressing, mobility, and toiletry.


Financial Criteria
The care recipient must be receiving Medicaid, which in the state of Washington is also called Apple Health. If one is not currently on Medicaid, they must be found eligible for Medicaid. As of 2018, the income limit for an individual who is aged, blind, or disabled is $750 / month. Married applicants can have a monthly income up to $1,125. Assets (resources) are also limited, and are set at $2,000 for a single individual and $3,000 for a married couple. Certain assets are exempt, meaning they are not counted towards eligibility purposes. These include one’s primary home (there is no equity limit), one automobile, prepaid burial arrangements, and some sentimental items, such as one’s wedding ring.

One should not be frustrated if they are over the income and / or asset limit, as this does not equate to automatic Medicaid disqualification. For those over the limit(s), it is highly suggested one consult a professional Medicaid planner, as Medicaid is complicated, and income and / or resources can be reallocated to meet the limits.

Applicants are not able to receive MAC services if they are receiving other long-term care supports via Medicaid.

 

Benefits and Services

With the Medicaid Alternative Care Program, a participant can receive as much as $550 per month in the following benefits and services:

  • Light housecleaning, grocery shopping, yard work, etc. 
  • Supportive services, such as counseling and support groups
  • Durable medical equipment and specialized supplies
  • Respite care – both in-home and out-of-home to give the primary caregiver a break
  • Training and education to assist the caregiver in providing care for the care recipient
  • Adult day care / Adult day health
  • Personal Emergency Response Systems (PERS)
  • Home delivered meals
  • Home modifications and basic repairs for safety purposes
  • Assisted technology
  • Transportation – for delivery of services
  • Educational assistance for persons with Alzheimer’s disease and their caregivers

 

How to Apply / Learn More

One must be receiving benefits from Medicaid in order to be eligible for the Medicaid Alternative Care Program. If not on Medicaid, the care receiver must first apply and be found eligible. To apply for Medicaid, one can do so online through Washington Connection or call the Department of Social Health Services (DSHS) at 877-501-2233.

Washington’s DSHS website offers additional information about the MAC program, and a downloadable brochure is available here. To apply for MAC, contact your local county Community Living Connections office. Click here to find contact information by county or call 855-567-0252.