Medicaid Transformation Demonstration

The state is leading strategic changes within Medicaid, allowing us to move toward a healthier Washington. The Medicaid transformation project demonstration is an agreement with the federal government which allows us to test new and innovative approaches to providing care.

Washington has already created a rebalanced system where individuals have a community care entitlement for Long-Term Services and Supports. Our LTSS system has earned the ranking of first in the nation by AARP for its high performance in supporting seniors, adults with disabilities and their family caregivers. Washington will build on the successes of our current system and create a “next generation” system of care focused on outcomes, supporting families in caring for loved ones, delaying or avoiding the need for more intensive Medicaid-funded LTSS where possible, creating better linkages to a reformed healthcare system and continuing its commitment to a robust Medicaid LTSS system for those that need it.

The Medicaid Transformation Demonstration, part of Healthier Washington, will transform the delivery system for the 25% of Washington's population served by Medicaid, engaging and supporting Apple Health clients, providers, and communities in achieving improved health, better care, and lower costs.

The demonstration has two main LTSS components

1. Medicaid Alternative Care — also known as MAC
   Creation of a benefit package for people who are eligible for Medicaid but not currently accessing Medicaid-funded LTSS. This benefit package will provide services for unpaid caregivers, designed to assist them in obtaining the support necessary to continue providing high-quality care and to focus on their own health and well-being.
    
2. Tailored Supports for Older Adults — also known as TSOA
   Establishment of a new eligibility category and benefit package for people at risk of future Medicaid LTSS use who currently do not meet Medicaid financial eligibility criteria. This is designed to help people avoid or delay impoverishment and the need for Medicaid-funded services.

MAC and TSOA include the following benefits

• Caregiver Assistance Services: Services that take the place of those typically performed by unpaid caregiver.
• Training and Education: Assist caregivers with gaining skills and knowledge to care for recipient.
• Specialized Medical Equipment & Supplies: Goods and supplies needed by the care receiver.
• Health maintenance & therapies: Clinical or therapeutic services for caregivers to remain in role or care receiver to remain at home.
• Personal Assistance Services: Supports involving the labor of another person to help recipient (TSOA only).

Additional Information

The demonstration includes creation of a supportive housing and employment benefit targeted to a group of people served by Medicaid:

• Supportive Housing - will provide supports to assist people to remain in their setting of choice. This increases independence and stability for the person and aims to avoid costly and disruptive institutional stays and homelessness.
• Supported Employment – will provide supports to assist people with functional disabilities to become job-ready and maintain employment.

Helpful Links

• MAC and TSOA Brochure (PDF)
• MTD Information for Caregivers
• MTD Information for Potential Service Providers
• Tribal FAQ PDF

For more information about the MTD and to sign-up for e-mail updates, please visit the Medicaid transformation webpage.