Washington Administrative Code › Title 388 - Social and Health Services, Department of › AGING AND ADULT SERVICES › Chapter 388-106 - Long-term care services › MEDICAID PERSONAL CARE (MPC) › Section 388-106-0210 - Am I eligible for medicaid personal care (MPC) funded services?

Current through Register Vol. 24-14, July 15, 2024
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.