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PDFWAC 182-513-1605

Medicaid alternative care (MAC)Eligibility.

(1) The person receiving care must meet the financial eligibility criteria for medicaid alternative care (MAC).
(2) To be eligible for MAC services, the person receiving care must:
(a) Be age fifty-five or older;
(b) Be assessed as meeting nursing facility level of care under WAC 388-106-0355, and choose to receive services under the MAC program instead of other long-term services and supports;
(c) Meet residency requirements under WAC 182-503-0520;
(d) Live at home and not in a residential or institutional setting;
(e) Have an eligible unpaid caregiver under WAC 388-106-1905;
(f) Meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b); and
(g) Be eligible for either:
(i) A noninstitutional medicaid program, which provides categorically needy (CN) or alternative benefit plan (ABP) scope of care under WAC 182-501-0060; or
(ii) An SSI-related CN program by using spousal impoverishment protections institutionalized (SIPI) spouse rules under WAC 182-513-1660.
(3) An applicant whose eligibility is limited to one or more of the following programs is not eligible for MAC:
(a) The medically needy program under WAC 182-519-0100;
(b) The medicare savings programs under WAC 182-517-0300;
(c) The family planning program under WAC 182-505-0115;
(d) The TAKE CHARGE program under WAC 182-532-720;
(e) The medical care services (MCS) program under WAC 182-508-0005;
(f) The alien emergency medical (AEM) program under WAC 182-507-0110 through 182-507-0120;
(g) The state funded long-term care for noncitizens program under WAC 182-507-0125;
(h) The kidney disease program under chapter 182-540 WAC; or
(i) The tailored supports for older adults (TSOA) program under WAC 182-513-1610.
(4) The following rules do not apply to services provided under the MAC benefit:
(a) Transfer of asset penalties under WAC 182-513-1363;
(b) Excess home equity under WAC 182-513-1350; and
(c) Estate recovery under chapter 182-527 WAC.
[Statutory Authority: RCW 41.05.021, 41.05.160, 2016 1st sp.s. c 36 § 213 (1)(e), section 1115 of the Social Security Act, and 42 C.F.R. §§ 431.400 through 431.428. WSR 17-12-019, § 182-513-1605, filed 5/30/17, effective 7/1/17.]
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