(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 55 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 chapter 182-517 WAC;
(c) The Washington apple health pregnancy and after-pregnancy coverage program under WAC 182-505-0115;
(d) The family planning only programs under chapter 182-532 WAC;
(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 and 41.05.160. WSR 25-12-036, s 182-513-1605, filed 5/28/25, effective 6/28/25; WSR 23-11-007, § 182-513-1605, filed 5/4/23, effective 6/4/23. 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.]