Statutes, codes, and regulations
Washington Administrative Code
Title 388 - Social and Health Services, Department ofAGING AND ADULT SERVICESChapter 388-106 - Long-term care services
MEDICAID PERSONAL CARE (MPC)
Section 388-106-0210 - Am I eligible for medicaid personal care (MPC) funded services?

Wash. Admin. Code § 388-106-0210

Download
PDF
Current through Register Vol. 24-21, November 1, 2024
Section 388-106-0210 - Am I eligible for medicaid personal care (MPC) funded services?

You are eligible for MPC-funded services when the department assesses your functional ability and determines that you meet all of the following criteria:

(1) You are certified as noninstitutional categorically needy, as defined in WAC 182-500-0020, or have been determined eligible for Washington apple health alternative benefit plan coverage, as described in WAC 182-505-0250. Categorically needy medical institutional programs described in chapter 182-513 and 182-515 WAC do not meet the criteria for MPC.
(2) You do not require the level of care furnished in a hospital or nursing facility, as defined in WAC 388-106-0355, an intermediate care facility for intellectual disability, as defined in WAC 388-825-3080 and WAC 388-828-4400, an institution providing psychiatric services for individuals under the age of twenty-one, or an institution for mental disease for individuals age sixty-five or over.
(3) You are functionally eligible which means one of the following applies:
(a) You have an unmet or partially met need for assistance with at least three of the following activities of daily living, as defined in WAC 388-106-0010:

For each Activity of Daily Living, the minimum level of
assistance required in:
Self-Performance, Status or Treatment Need is: Support Provided is:
Eating N/A Setup
Toileting Supervision N/A
Bathing Supervision N/A
Dressing Supervision N/A
Transfer Supervision Setup
Bed Mobility Supervision Setup
Walk in Room OR Locomotion in Room OR Locomotion Outside Immediate Living Environment Supervision Setup
Medication Management Assistance Required N/A
Personal Hygiene Supervision N/A
Body care which includes: Needs or Received/Needs N/A
*Application of ointment or lotions;
*Toenails trimmed;
*Dry bandage changes;
(* = if you are over eighteen years of age or older) or Passive range of motion treatment (if you are four years of age or older). Need: Coded as "Yes"

Your need for assistance in any of the activities listed in subsection (a) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose of determining your functional eligibility.

; or

(b) You have an unmet or partially met need for assistance or the activity did not occur (because you were unable or no provider was available) with at least one or more of the following:

For each Activity of Daily Living, the minimum level of assistance required in
Self-Performance, Status or Treatment Need is: Support Provided is:
Eating Supervision One person physical assist
Toileting Extensive Assistance One person physical assist
Bathing Physical Help/ part of bathing One person physical assist
Dressing Extensive Assistance One person physical assist
Transfer Extensive Assistance One person physical assist
Bed Mobility and Turning and repositioning Limited Assistance and Need One person physical assist
Walk in Room OR Locomotion in Room OR Locomotion Outside Immediate Living Environment Extensive Assistance One person physical assist
Medication Management Assistance Required Daily N/A
Personal Hygiene Extensive Assistance One person physical assist
Body care which includes: Needs or Received/Needs N/A
*Application of ointment or lotions;
*Toenails trimmed;
*Dry bandage changes;
(* = if you are eighteen years of age or older) or Passive range of motion treatment (if you are four years of age or older). Need: Coded as "Yes"

Your need for assistance in any of the activities listed in subsection (b) of this section did not occur because you were unable or no provider was available to assist you will be counted for the purpose determining your functional eligibility.

Wash. Admin. Code § 388-106-0210

Amended by WSR 15-03-038, Filed 1/12/2015, effective 2/12/2015
Amended by WSR 15-11-049, Filed 5/15/2015, effective 7/1/2015

Statutory Authority: RCW 74.08.090 and 74.09.520. 12-14-064, § 388-106-0210, filed 6/29/12, effective 7/30/12; 05-11-082, § 388-106-0210, filed 5/17/05, effective 6/17/05.