Washington Medicaid pays for in-home personal care and related services through 2 programs, including the Community Options Program Entry System (COPES) Waiver and the Individual and Family Services (IFS) Waiver. DSHS Aging and Long-Term Support Administration (Home and Community Services) runs COPES, CFC and MPC; COPES is a wraparound to CFC and serves over 51,000 clients (WAC 388-106-0300 through 0335). DDA runs five 1915(c) waivers: Basic Plus, CIIBS, Community Protection, Core and IFS. Home care agencies licensed under chapter 70.127 RCW are among the qualified provider types; confirm EVV and managed care details with DSHS.
Yes. Personal care is covered under the Community First Choice (CFC) 1915(k) state plan option (personal care, nurse delegation, assistive technology, limited PERS) for people at nursing facility level of care, and under Medicaid Personal Care (MPC) for others who qualify; since 2015-07-01 personal care is no longer a COPES service.
Which Washington waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Community Options Program Entry System (COPES) Waiver
Population
Adults 18+ who are blind or have a disability, or adults 65+, who meet nursing facility level of care by CARE assessment, are institutional categorically needy eligible, and have needs beyond what CFC covers.
DDA-eligible people with intellectual and developmental disabilities who live in the family home (or a State or Tribal dependency placement with family).
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
Up to 10 caregivers on Starter, 50 on Growth.
More than 50 caregivers? We'll put together a custom Scale plan for your agency.
