Washington Medicaid Alternative Care (MAC) Program

Program Description

The Washington Medicaid Alternative Care (MAC) program provides supportive services to unpaid primary caregivers of elderly Washington residents. MAC is intended to assist the caregiver and help prevent burnout, as well as prevent premature nursing home placement of the care recipient. 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. There is a very similar program to MAC also under the Medicaid Transformation Project 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 the care recipient and their caregiver.

General Requirements

Caregiver Requirements

• Must be no younger than 18 years of age.
• Must be providing care to the care recipient as their primary caregiver and 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 what is provided in a nursing home. In addition, the care receiver must require assistance with some Activities of Daily Living (ADLs), such as bathing, grooming, dressing, mobility, and toiletry.

Financial Requirements

The care recipient must be receiving Medicaid, which is also called Apple Health in the state of Washington. If one is not currently on Medicaid, they must apply and be found eligible for Medicaid.

Income Limits
As of 2023, the income limit for an individual who is aged, blind, or disabled is $914 a month. Couples can have a monthly income up to $1,371, regardless of whether both spouses are applying. (The income limits are consistent to 100% of the Federal Benefit Rate for a household of one and a household of two). 

Asset Limits
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 toward 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.

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

Over the Financial Limits?

Washington residents who exceed these income and asset limits but still cannot afford their care costs still might qualify for this program by working with a Medicaid planning professional. They are trained to assist applicants who find themselves in this very situation and are well versed in reallocating income and assets so that it isn’t counted toward the limits. For instance, extra income can be deposited into a Miller Trust, also referred to as a Qualified Income Trust, and an Irrevocable Funeral Trust can be used to lower one’s countable assets.

Benefits and Services

With the Medicaid Alternative Care program, a participant can receive as much as $743 per month in the following benefits and services:

• Light housecleaning, grocery shopping, yardwork, 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
• Assistive technology
• Transportation – for delivery of services
• Educational assistance for persons with Alzheimer’s disease and their caregivers

How to Apply / Learn More

Medicaid
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 by calling the Department of Social and Health Services (DSHS) at 877-501-2233.

MAC
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.