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What Do Washington State Benefit Programs Cover?

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What Washington State Benefit Programs Are There And Who Is Eligible?

If you’re a Washington State resident and in need of a benefit program, there are a variety available that you could be eligible for. Eligibility may differ for each one and you would need to supply information about your finances and your life situation to be accepted on to a benefit program.

The great news is that many of the benefit programs can potentially cover a range of durable medical equipment and supplies that many people needing care find invaluable for daily life, as long as there is agreement by your program.  

If you meet the eligibility requirements and have a medical need for equipment or supplies approved by your case manager or physician, the products you’re looking for may be covered by your program.

From shower chairs to adaptive eating equipment, there could be supportive supplies available with your benefit program once you have been approved for eligibility.

If you would like to read more about Washington State benefit programs, who is eligible and what supplies your program could provide, visit the insurance tab on our website. 

 

What Is Medicaid And Managed Medicaid?

Medicaid/Apple Health 

In Washington State, Medicaid is now called Apple Health. Apple Health provides a range of health services, such as medical supplies, cancer screening and other preventative care options to those who are eligible.

The Affordable Care Act (ACA) enables many Washington State residents to access affordable health insurance at a low or no cost, depending on individual circumstances. These programs are administered by the state and paid for by state or federal funds.

Eligibility for Medicaid/Apple Health is decided on a case-by-case basis, with most people who fit the criteria coming from a low income or special health need position. Adults aged 19-64 may qualify, but only if they are not already on Medicare. You can apply for enrollment onto Apple Health at any time as it is a year-round program, if you’re eligible.

This program can also cover families and pregnant women who have a household income that is below a certain level which can fluctuate a little each year.

It’s good to know that medical supplies can potentially be covered under Medicaid/Apple Health, subject to approval. These products can range from general health supplies to incontinence products. 

At Professional Medical Corp, we are proud to specialise in incontinence supplies and have a full spectrum collection from a range of trusted suppliers who are covered under the Medicaid program.

 

Managed Medicaid

You may be asking, “What is Managed Medicaid?” Well, many Apple Health Medicaid clients are covered through something called managed care. This is a pre-paid system for the delivery of medical and health care to individuals and families who are eligible. 

It works by Apple Health paying a monthly premium to a health plan provider for your coverage. This can include primary, preventative or specialist medical and health care. There will be a choice of plans when you enroll so you can be covered by the right plan and provider, as long as you meet eligibility requirements.

All Apple Health plans cover the same basic services but some may differ on other products or services. It’s best to check with the health plan so you know what you’re approved to access.

As with Apple Health/Medicaid, you may be able to access medical products and supplies with Managed Medicaid if the program deems you eligible. Wound care, diabetes care products and incontinence supplies are usually included, along with a range of other medical goods.

You can find further information about Managed Medicaid and the medical supplies that may be covered by visiting the relevant section on our website. You can learn more about all your trusted brands and supplies that you need and research in greater detail about your eligible plan’s requirements.

 

What Is Medicaid Fee-For-Service?

If you receive Medicaid, you might have heard of this service but don’t quite know what it’s for. The term refers to how medical professionals or companies get paid to supply you with a medical service if you’re eligible. 

With this service, if you visit a doctor with pre-approval from your program, the doctor can request direct payment from Medicaid. Most services are potentially covered if pre-approved but there may be times where a supplement is paid for some services. 

Durable medical equipment and medical supplies may also be covered under the Fee-For-Service, such as incontinence products, wound care or breast pumps. It’s best to check with your program to make sure you meet eligibility requirements for products and services you need.

COPES Program

COPES or the Community Options Program Entry System is a Washington State waiver program for those people who require nursing home care to potentially allow them to have care at home or in another location, such as an assisted living residence, if approved.

To be COPES eligible, a person needs to be 65 and over or be between 19-64 with a disability. You should also be eligible for Medicaid and need help with at least two daily self-care activities, such as getting washed or dressed and require the type of care nursing homes provide.

There is a more involved process if the person applying is part of a married couple and it’s important to get advice regarding your financial situation from the COPES program to make sure you’re eligible and can access the services you need.

It’s good to note that this program may also cover additional supportive processes, products and services to enable an improved transition to a more independent or assisted lifestyle,  if you’re confirmed as eligible. These supports could cover home modifications, medical supplies and products to additionally aid clients.

If you want to know what the COPES program might cover in terms of medical equipment and supplies, we have a clear description and list on our website to support you in your requirements. You’ll find a summary of bathroom equipment, reachers, adaptive eating utensils and transport wheelchairs to browse.

What Are MAC/TSOA?

MAC And TSOA

MAC and TSOA are Medicaid programs that are relatively new and both provide free services to unpaid caregivers who look after family or other dependents that are 55 and over. In addition, TSOA also supports people who don’t have an unpaid carer.

The major difference between MAC/TSOA and traditional care programs is that they support the caregivers as well as the person needing care, whereas traditional programs support only the person who needs care.

MAC and TSOA benefits are very similar, but MAC is for people requiring care who could be eligible for Medicaid but choose not to go down this route. TSOA is for people who aren’t currently eligible for Medicaid.

To qualify for MAC or TSOA, you need to be financially eligible, which means your financial situation will be assessed. This may take into account how resource eligible you are, in terms of the value of your financial assets. Plus, you should need the same level of care given in a nursing home.

You will find that the coverage of home medical equipment and supplies under MAC and TSOA are quite similar to the other Washington State care plans. As a MAC/TSOA provider, we are able to work with you or your caregiver to make sure you have the right medical equipment and supplies to best support your situation, as long as your eligibility for these products has been approved by your program.

There is a range of covered items, such as reachers, adaptive equipment, incontinence supplies and bathroom supports, like grab bars and shower chairs, for you to browse on our site to help you live safely and more independently at home.

FAQs

  1.   Who is eligible for Medicaid?

To be eligible for Medicaid, you need to be a resident of the state of Washington, a U.S. national or a permanent resident. If you have legal immigration status, you can also qualify. You should require health care assistance and be in the low or very low-income bracket. You also need to be one of the following:

  •       Pregnant or responsible for a child who is 18 or under
  •       Blind
  •       Disabled or have a household family member who is disabled
  •       65 years old or over

 

There are also household income levels that you need to fall into to be eligible. These can change depending on the size of your household, its total income and the year you apply.

  1. What’s the difference between Medicaid and Managed Medicaid? 

The main difference between the two programs is that managed Medicaid pays managed care organisations (MCOs) a set fee to provide care for the participant. This care is given through the managed care organisation’s own doctors, medical professionals and hospital networks.

The MCO is then responsible for taking care of the individual to make sure they have the best possible care resources in line with eligibility conditions.

  1. Where can I buy my medical supplies?

If you’re on one of the Washington State benefit programs or are researching your eligibility for one of these, then you need to know that your medical equipment and supplies are potentially covered if approved by your program. We have clear information summaries with signposted supplies and equipment on our website to better support you in your care under our category "Medicaid Approved". 

Just head on over to our website to browse all relevant products and find exactly what you need.

We’re Here To Help…

Hopefully, you’ll now have all the information you need about Washington State benefit programs and what could be covered for each one to better support your care.

But if you need anything else, we’re here to give you a helping hand.

If you would like to speak with our customer care experts for great advice about medical supplies or equipment then please contact us on: 

Phone:

(206) 366-9543 or (800) 741-3996

 Our lines are open Monday-Friday 8.30am-5.00pm PT. 

Alternatively, you can email us at:

admin@professionalmedicalcorp.com

Author:

Rachel Bashford, Clearcreate Copywriting

 

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  • Rachel Bashford
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