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Beginning July 1, 2025, the Health Care Authority (HCA) intends to implement medical respite care (MRC) as a Medicaid-covered health-related social needs (HRSN) service for eligible Apple Health (Medicaid) clients under the Medicaid Transformation Project 2.0 (MTP 2.0) waiver. HRSN services are one component of promoting positive health outcomes and may address the need for housing or food insecurity that exacerbate poor health or quality-of-life outcomes.
Managed care organizations (MCO) will administer MRC for managed care enrollees. For Apple Health clients not enrolled with an MCO, MRC will be available to these fee-for-service (FFS) clients by billing HCA directly. Providers are encouraged to seek more information from MCOs to initiate contracting for this new Medicaid service for July 2025 implementation.
Apple Health managed care plans
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Medical respite care provides recuperative post-acute care for people experiencing homelessness or at risk for homelessness, as defined by 24 CFR 91.5 with the exception of the annual income requirement in 24 CFR 91.5 (1) (i), who are too ill or frail to recover from an illness or injury while living on the streets, but who no longer require a hospital stay. The recuperative care services of MRC may be provided to eligible Apple Health clients for up to 90 days at a time and no more than 6 months per rolling 12-month period.
Service procedure code T2033 should be used for all MRC claims as it is considered to encompass key components of MRC models under the National Institute for Medical Respite Care (NIMRC) that include:
- 24-hour access to a bed
- Three meals per day
- Transportation to all medical appointments
- Access to a phone for telehealth and/or communications related to medical needs
- A safe space to store personal items
- A wellness check at least once every 24 hours by medical respite staff (clinical or non-clinical)
Under ESSB 5693, HCA has funding to pay for MRC for Apple Health fee-for-service (FFS) clients through dates of service on and before June 30, 2025. Beginning July 1, 2025, MRC will be covered using MTP 2.0 waiver funds.
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