Washington home care programs

Home health: the medical benefit

In Washington, skilled home health is Home Health Services (Apple Health) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with Washington Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In Washington the agency route is Home care agency services. No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

Washington's consumer-directed option is Community First Choice (CFC) and Medicaid Personal Care (MPC) — individual provider option (IP) and New Freedom Consumer Directed Services. The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: Community First Choice (CFC) and Medicaid Personal Care (MPC) — individual provider option (IP) and New Freedom Consumer Directed Services allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

Washington has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (Community First Choice (CFC) and Medicaid Personal Care (MPC) — individual provider option (IP) and New Freedom Consumer Directed Services), by the hour, as the participant's chosen aide.

Other ways Washington pays for care at home

Waiver in-home services: Community Options Program Entry System (COPES) and Developmental Disabilities Administration HCBS waivers (DDA). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

State-funded: WA Cares Fund (Long-Term Services and Supports Trust). Paid from state funds outside Medicaid, for people who do not qualify for Medicaid or are waiting for it.

Also: Medicaid Alternative Care and Tailored Supports for Older Adults (MAC).

Which one fits

• Needs nursing, wound care, injections or therapy at home: home health (Home Health Services (Apple Health) (HHA)).
• Needs daily help and wants an agency to supply and manage the aide: Home care agency services.
• Wants to choose the aide, including a relative where allowed: Community First Choice (CFC) and Medicaid Personal Care (MPC) — individual provider option (IP) and New Freedom Consumer Directed Services.
• Meets nursing-home level of care and needs more than personal care: Community Options Program Entry System (COPES) and Developmental Disabilities Administration HCBS waivers (DDA).