Nursing Assistant Certified Reimbursement Forms

If you have any questions about Nursing Assistant Certified (NAC) training reimbursement, please contact Jamie Franzen, Analyst, at (360) 725-2438 or, or Tiffany Hills, Nursing Home Rates Manager, at (360) 725-2472 or

REMINDER: Per the Reimbursement Form Instructions, the reimbursement packets must be postmarked and submitted thirty days after the end of the quarter. The deadline schedule is as follows:

Quarter 1 – April 30th

Quarter 2 – July 31st

Quarter 3 – October 31st

Quarter 4 - January 31st (following year)


If you have any questions about the Nursing Assistant program, please visit the Nursing Assistant program website.

Reimbursement Form

2017 Facility Totals

Online Module Training Reimbursement Policy

Reimbursement Form Instructions 

Help Sheet and Common Errors 

Policy & Procedures

2018 Medicaid percentage used to calculate reimbursement Excel