Clarifying Information
MAC creates a new optional choice for people who are eligible for CN or ABP Medicaid but not currently accessing Medicaid-funded LTSS and provides services to unpaid caregivers designed to assist them in providing quality care to family members while also improving their own well-being. MAC offer services to support the needs of the person who is providing care to a family member so they are able to continue to provide care.
People who choose services under the MAC benefit must make a choice between receiving MAC services or traditional LTSS services (such as the COPES waiver or Community First Choice (CFC)). A person who chooses to receive CFC may not also receive support services for an unpaid family member. Â
What are the financial eligibility criteria for MAC?
The person who receives the care must be:
- Age 55 or older and live in a home setting
- A Washington State resident
- Meet the citizenship and immigration eligibility for federally funded Medicaid
- Eligible for CN or ABP Medicaid coverage
- Eligible for SSI-related CN Medicaid if spousal impoverishment protections are applied.Â
If a person wants to apply for MAC services and the person is not already eligible for Medicaid, they must submit an HCA 18-005 Application for Aged, Blind, Disabled/Long-term care, or may apply for MAGI coverage by applying through the Washington Healthplanfinder. A person may be authorized services under the Tailored Supports for Older Adults (TSOA) program while the Medicaid application is being processed.Â
What are the functional eligibility criteria for MAC?
- The person receiving care must meet nursing facility level of care (NFLOC) and doesn't need to have a disability determination.
- The person providing care must be age 18 or older and meet the criteria under WAC 388-106-1905 WAC.
A person may be prescreened for MAC services by either Home and Community Services or by the Area Agency on Aging (AAA) office. However all services are authorized at the AAA.
How do spousal impoverishment protections work for a MAC applicant?
Spousal impoverishment protections apply to a MAC applicant who meets the following criteria:
- The applicant is married and the spouse doesn't live in an institution;
- The applicant isn’t otherwise eligible for noninstitutional SSI-related CN Medicaid because of:
- income deemed available to them from a nonapplying spouse; or
- resources over the $3000 couple limit;
- The applicant’s separate net income is below the SSI federal benefit rate.
For more information see Clarifying Information under WACÂ 182-513-1660.
What LTSS financial rules don’t apply to MAC services?
Certain provisions that apply to traditional long-term care services don’t apply to people who are eligible for MAC. These include:
Recovery and TEFRA liens (Chapter 182-527Â WAC)
Estate Recovery doesn't apply to services paid by the MAC program. Likewise the state can’t establish a TEFRA lien for the cost of services provided under this program.
Worker Responsibilities
The AAA worker will notify financial staff using the 14-443 communication form when a client has been approved for MAC services.Â
Financial staff are responsible for ongoing case maintenance on MAC clients. If the case is managed by the CSO, the HCS financial worker will transfer the case into HCS to case manage and update the case to show the MAC approval and start date. This includes processing food assistance requests if applicable.  Â
Note: HCS staff don’t manage MAGI or Breast and Cervical Cancer cases. Â