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Revised June 3, 2008 |
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Purpose: To explain a Medicaid program called Medicaid Personal Care (MPC) for individuals eligible for a non institutional CN-P program and meeting the functional criteria for personal care services. |
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Clarifying Information Medicaid Personal Care (MPC): A Medicaid program that is allowed under Washington State’s Medicaid State Plan, this program provides assistance with activities of daily living to individuals who receive SSI or are approved for other CN medical programs such as TANF, GAX, and SSI-related medical. Functional eligibility for this program requires unmet needs as outlined in WAC 388-106-0210. Services are available in the client’s own home, adult family homes, and boarding homes with an Adult Residential Care (ARC) contract. The program is administered by Home and Community Services (HCS) and Developmental Disabilities (DDD) administrations. An assessment is done by a case manager, nurse or social worker from DDD, HCS or Area Agency on Aging (AAA). Clients must meet the functional criteria based on the social service assessment AND the financial eligibility based on eligibility for a non institutional CN-P Medicaid program.
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Agency Responsibilities Financial staff determines financial eligibility for financial and medical assistance programs. The DDD, HCS or AAA case manager responsible for placement and case management services determines functional eligibility, inititates the payment to the provider, the amount the client must pay to the facility for their cost of care and notifies the client. The assigned case manager/social worker indicates what services are authorized with the start date, the state daily rate, the current address and any other pertinent information needed to process the case such as if a payee or power of attorney is involved in the case. The assigned case manager/social worker determines the functional eligibility for the service and notifies the client and provider of changes in the service including the client responsibility; the financial worker is responsible to determine the financial eligibility for Medicaid. Changes need to be reported back and forth between the financial worker and assigned case manager/social worker HCS social workers use the DSHS 14-443 Financial/Social Service communication form. DDD case managers use the DSHS 15-345 CSO/DDD Communication . | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Worker Responsibilities Indicate M for MPC service in ACES on the INST screen under the HCBS type field. Indicate the start date of the service and the approving agency under the approval source. Indicate the payment auth date. For MPC the start date of the service and the payment auth date is the same date. If the client is living in an alternate living facility, the top line (facility section) of the INST screen must be completed. A provider number is not needed for an alternate living facility, but the entry date, level of care, payment authorization date and state rate are needed. If a client is on services with DDD, HCS or AAA always indicate the agency name and mailing address on the AREP screen in ACES to receive copies of notices. Services authorized by DDD, HCS and AAA are tied to eligibility for CN-P Medicaid. If Medicaid closes, the service authorized by the social worker/case manager must close. Clients must be eligible for a non institutional CN-P Medicaid program in order to receive MPC. If MPC services end per the authorized agency indicate the service end date on the HCBS field in the month services ended. If in an adult family home or boarding home a discharge date would be required. Delete the service in the ongoing months. Delete the authorized agency on the AREP screen. No notice regarding the MPC service is required by the financial worker, the authorized agency (DDD, HCS or AAA) is responsible to send the notice to the client when MPC services end, change or if the amount the client pays to the ALF provider changes. The financial worker is responsible to send notices on any changes in the Medicaid eligibility. Clients residing in an alternate living facility such as an adult family home or DDD group home that have countable income over the CNIL can be considered for Non Institutional SSI related clients living in an Adult Family Home or Boarding Home (G03). Some clients are put on a HCS Waiver or DDD Waiver program. These clients are not on MPC, but on an "institutionalized" program. (C01) If client is not eligible for a non-institutional CNP program, notify the agency authorizing MPC services that client is not financially eligible for MPC. Client may be considered for a CN-P institutional Waiver program such as COPES. See HCS CN-P Waivers or DDD CN-P Waivers for rules describing Waiver services authorized by each agency. The authorizing agency (DDD, HCS or AAA) will notify the financial worker of the type of service. For MPC clients receiving Washington Medicaid Integrated Partnership Managed Care Pilot, (WMIP)follow the instructions in that section. For MPC clients receiving Medicare/Medicaid Integrated Program, (MMIP) follow the instructions in that section. A client going from MPC to Waiver must qualify under the rules for the Waiver program including transfer of asset and excess home equity rules that apply to Waiver/institutional programs. Some CN-P programs such as HWD (S08) or Childrens Medical do not have resource requirements, but Waiver programs do have resource requirements. Breast and Cervical Cancer (S30) program is determined by the Health Department not DSHS, an application must be submitted for Waiver/LTC services. Social workers and case managers should consult financial service staff prior to switching a MPC case to a Waiver case to make sure the client is eligible under Waiver rules. | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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WAC references for Medicaid Personal Care (MPC)
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Medicaid Personal Care Chart ACES CN Medical Coverage Group Codes
(Financially eligible for MPC/WPC)
*These are time limited programs. You should be aware that the service will only be available as long as the client is receiving medical under one of these groups and explain this at the time of the assessment.
**Institutional medical (L02), including waiver services (C01), have higher income and resource limits. The resource limit for G03 is the same as SSI, but the income standard is higher. Clients may no longer qualify for CN medical programs if those institutional medical or waiver services end. Before authorizing MPC services, check ACES or contact a financial services worker to ensure that the client will be eligible for CN medical under a non-institutional medical program.
When you check eligibility in ACES Online, make sure that the Assistance Unit (AU) is active (“A”) and that your client is a recipient (“RE”) in the AU.
ACES Non-Qualified Alien Coverage Group Codes
(NOT financially eligible for MPC/WPC)
Other Non-Qualified Codes
Not financially eligible for MPC
**** Medicare Savings Programs or MSP are not Medicaid programs, but Medicare cost sharing programs. It is possible a client can be receiving a Medicaid program in addition to a MPS program. An MSP program only cannot authorize MPC.
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ACES Instructions ACES instructions for MPC are in the process of being updated. Please refer to Worker Responsibilities above for current instructions. ACES instructions for long-term care and Waiver programs
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