Long-term services and supports (LTSS) manual

Medicaid Alternative Care (MAC)

Revised Date: 
July 1, 2017

Purpose: To describe the Medicaid Alternative Care program and the eligibility requirements for a person to become eligible.

WAC 182-513-1600 Medicaid Alternative Care (MAC)

Effective July 1, 2017

Medicaid alternative care (MAC) is a Washington apple health benefit authorized under section 1115 of the Social Security Act. It enables the medicaid agency and the agency's designees to deliver an array of person-centered long-term services and supports (LTSS) to unpaid caregivers caring for a medicaid-eligible person who meets nursing facility level of care under WAC 388-106-0355.

  1. For services included with the MAC benefit package, see WAC 388-106-1900 through 388-106-1990.
  2. For financial eligibility for MAC services, see WAC 182-513-1605.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1605 Medicaid alternative care (MAC) — Eligibility.

Effective July 1, 2017

  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:
    1. Be age fifty-five or older;
    2. 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;
    3. Meet residency requirements under WAC 182-503-0520;
    4. Live at home and not in a residential or institutional setting;
    5. Have an eligible unpaid caregiver under WAC 388-106-1905;
    6. Meet citizenship and immigration status requirements under WAC 182-503-0535 (2)(a) or (b); and
    7. Be eligible for either:
      1. A noninstitutional medicaid program, which provides categorically needy (CN) or alternative benefit plan (ABP) scope of care under WAC 182-501-0060; or
      2. 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:
    1. The medically needy program under WAC 182-519-0100;
    2. The medicare savings programs under WAC 182-517-0300;
    3. The family planning program under WAC 182-505-0115;
    4. The TAKE CHARGE program under WAC 182-532-720;
    5. The medical care services (MCS) program under WAC 182-508-0005;
    6. The alien emergency medical (AEM) program under WAC 182-507-0110 through 182-507-0120;
    7. The state funded long-term care for noncitizens program under WAC 182-507-0125;
    8. The kidney disease program under chapter 182-540 WAC; or
    9. 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:
    1. Transfer of asset penalties under WAC 182-513-1363;
    2. Excess home equity under WAC 182-513-1350; and
    3. Estate recovery under chapter 182-527 WAC. 

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

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.  

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. 

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. 

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 WAC 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 182-527 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. 

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.   

Note:  HCS staff don’t manage MAGI or Breast and Cervical Cancer cases.