HCS state-funded residential program through the Medical Care Service (MCS) program

State-funded residential

Home and Community Services (HCS) has a state-funded residential program for those eligible for Medical Care Services (MCS).  The functional requirements are the same as for Medical Personal Care (MPC).

ACES medical coverage group is A01, A05, or A24. The state-funded LTSS program is described in WAC 388-106-0905.

What services may I receive under state funded residential care? WAC 388-106-0900

Clarifying Information

• A01 is used for clients who meet aged, blind or disabled criteria. 
• A05 is used for clients meeting ABD incapacity, but not disability criteria. 
• A24 is used for victims of human trafficking. Public Benefit Eligibility for Survivors of Certain Crimes | DSHS (wa.gov)
• To be eligible for A01, A05, or A24, the client must be eligible for the HEN referral program or the ABD cash assistance program.
• Room and Board calculations for clients in an alternate living facility (ALF) are not calculated in ACES and notices to clients will need to be sent by social services.

Am I eligible to receive state-funded residential care services? WAC 388-106-0905

• Lawfully present clients, not subject to the 5-year bar, who permanently reside in the US under color of law (PRUCOL) (NQ).
• Must be eligible for ABD cash or HEN referral program.
• One applicant/recipient per AU.
• Scope of care is state-funded Medical Care Services (MCS).
• Covers the state-funded residential program and state-funded nursing facility program.
• Undocumented individuals are not eligible for A01/A05 coverage.

How do I approve a new A01/A05/A24 case?

• Applications: The client must apply for ABD cash assistance to be able to look at the MCS eligibility.
• Screening: 'A' track AU's will not auto populate in screening; however the medical coverage group will be allowed as a selection in the dropdown list.
• Default will be MA/D/A01 and will switch to the correct coverage type when finalizing the AU.
  • Determine if the client is an eligible noncitizen who needs LTC residential or nursing home services.
  • Did the client apply for cash assistance?
  • Is the client functionally eligible for LTC services?
  • If the answer is yes to 1, 2, and 3 screen in a HEN AU and an A01 AU. (Clients who are eligible for LTC services meet the incapacity criteria for HEN).
  • Process the HEN AU first then finalize the A01/A05 AU.
  • Determine 'durational' requirements for ABD/HEN program for clients under 65, not blind or disabled.
    • Regions 1 and 3: Using Barcode, complete a 14-084 referral to the CSD incapacity worker.
    • Region 2: Complete a referral to the Region 2 HCS social worker for a disability determination.
    • Indicate on the 14-084 the following;
      • "Per approved ETR to WAC 388-400-0070, HCS has approved HEN/MCS case. Client meets LTSS functional requirements-disability determination is needed".
  • Notify the HCS social worker that client has been opened on HEN/MCS medical coverage so they can issue a notice to the client regarding the room and board calculation.
    • Indicate the client's current income to the social worker.
  • Set a reminder to check on disability/duration with the CSD incapacity worker if applicable.
• WAC 182-508-0005 for the state funded MCS program.
• WAC 388-400-0060 for the ABD cash program.
• WAC 388-513-1315 (11) which describes the ABD cash and MCS program as it applies to ALTSA services.

Disability instructions for ABD cash are found in the EAZ social service manual.

State-Funded Long Term Care Program for Noncitizens

State-funded LTC for noncitizens not eligible under ABD cash or MCS. This program is limited to 45 slots due to legislative funding limitations and requires a preapproval by ALTSA HQ. The state-funded LTC program can be used in a nursing facility, residential or home setting.