PDFWAC 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:
■ 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).
Needs or Received/Needs
Need: Coded as "Yes"
N/A
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:
■ 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).
Needs or Received/Needs
Need: Coded as "Yes"
N/A
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.
[Statutory Authority: RCW 74.08.090 and 74.09.520. WSR 15-11-049, § 388-106-0210, filed 5/15/15, effective 7/1/15; WSR 15-03-038, § 388-106-0210, filed 1/12/15, effective 2/12/15; WSR 12-14-064, § 388-106-0210, filed 6/29/12, effective 7/30/12; WSR 05-11-082, § 388-106-0210, filed 5/17/05, effective 6/17/05.]