The Medicaid Personal Care (MPC) Program provides low-income elderly and disabled Washington residents with personal care services. Services are provided to individuals who 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 Self-Directed Care 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 it 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.
There are both financial and functional qualifiers for the MPC program. Functionally, participants must have a need for assistance with at least 3 of the following activities of daily living:
- Bed Mobility
- Medication Management
- Mobility Around and Outside the Home
- Personal Hygiene
- 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 2023, this limit is $914 per month for a single applicant and $1,371 for a married couple 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 for individuals and $3,000 for a married couple. There are no financial protections for a spouse when their husband or wife needs more care. One’s home is considered exempt, regardless of equity value. Other exemptions include personal effects, household items, a vehicle, and pre-arranged burial plans.
Past asset transfers for five years prior to the date of application are eligible for review by Medicaid. This is to make sure the applicant did not give away or transfer assets under market value with the goal of qualifying for this program. This is called the Medicaid Look-Back Period, and if one is found to be in violation of this rule, a period of Medicaid ineligibility may result.
Over the Financial Limits?
For those who are unsure whether they are eligible for the MPC program, we suggest they consult with 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 and instrumental activities of daily living, such as bathing, eating, toileting, mobility, grooming, personal hygiene, meal preparation, shopping for essential items, and housecleaning. 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 who reside in adult residential communities, such as assisted living, can also receive personal care services. However, this program does not include individuals who 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 program by calling their local Home and Community Services office or applying online at this link. Finally, applicants are also able 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 New Freedom 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 waiver program called COPES, which covers a wider range of services, including home modifications to help aging in place.