TSOA and MAC Programs in Washington: Caregiver Support Beyond Medicaid

For institutional and waiver Medicaid programs, the key figures are a $2,982 monthly income threshold and a $2,000 countable-asset limit. Income above the threshold does not necessarily end eligibility; Washington also allows a Medically Needy Spend-Down pathway. Private-pay care in Washington averages $7,600 per month for assisted living and over $13,000 for a nursing home.

That's the gap TSOA and MAC were designed to fill. TSOA helps people who are not financially eligible for Apple Health, while MAC supports people who are financially eligible for Medicaid but choose not to receive standard long-term-care services.

What TSOA Covers

Tailored Supports for Older Adults (TSOA) serves Washington residents age 55 and older who meet a nursing facility level of care but are not financially eligible for Apple Health (Medicaid). The program comes in two tracks:

TSOA with an unpaid caregiver provides respite care, home-delivered meals, personal care services, minor home modifications, adult day care, and training for the family caregiver. The goal is to prevent burnout for the adult child or spouse providing daily care, while keeping the parent safely at home.

TSOA for individuals living alone provides similar services for older adults who don't have an unpaid caregiver — personal care, home-delivered meals, and adult day services to help them maintain independence.

To qualify, the applicant must be 55 or older, meet the functional threshold for nursing facility level of care (assessed through the same CARE assessment used for Medicaid programs), and have gross income below the TSOA program limit. Check the current TSOA limit rather than applying the $2,982 Medicaid threshold.

What MAC Covers

Medicaid Alternative Care (MAC) is a companion program to TSOA, but with a critical difference: MAC serves individuals who are financially eligible for Medicaid but choose not to receive standard long-term care services. Instead, the benefit goes to supporting their unpaid family caregiver.

MAC covers respite care, caregiver training, support groups, and adaptive equipment. The applicant must be 55 or older, meet nursing facility level of care, and have an unpaid caregiver (typically a spouse or adult child) providing regular assistance.

The logic behind MAC is straightforward: if a Medicaid-eligible person is being cared for at home by a family member, it costs the state far less than institutional or waiver-funded community care. MAC invests a fraction of those savings in keeping the caregiver functioning.

The Enrollment Pause

Both TSOA and MAC paused new enrollments on December 1, 2025, due to projected budget overruns. Existing participants continue to receive services, but the programs are currently operating with waitlists for new applicants.

This pause has significantly increased pressure on family caregivers who were counting on these programs as a bridge between private-pay and Medicaid eligibility. For families affected by the pause, the practical alternatives include:

• Community First Choice (CFC) — if the parent does qualify for Medicaid, CFC is an entitlement program with no waitlist. It covers personal care in the home, an adult family home, or assisted living.
• Family Caregiver Support Program — administered through local Area Agencies on Aging, this federally funded program provides limited respite, counseling, and supplemental services. It's not as comprehensive as TSOA, but it has no Medicaid eligibility requirement.
• The WA Cares Fund — beginning July 1, 2026, eligible Washington residents can access up to $36,500 in lifetime benefits for long-term care, including paying a family member (even a spouse) for in-home care.
• Veterans Aid and Attendance — for veterans or surviving spouses of veterans, this VA pension supplement can offset care costs without requiring Medicaid eligibility.

What to Do Right Now

If your parent may qualify for TSOA or MAC, contact your local Area Agency on Aging to get on the waitlist. Even with the enrollment pause, waitlist position matters when slots reopen.

In the meantime, request a CARE assessment through DSHS Home and Community Services. The assessment determines your parent's functional level of care regardless of which program they ultimately access, and it's a prerequisite for TSOA, MAC, CFC, and COPES alike.

For a full walkthrough of all available care programs in Washington — including how to navigate eligibility and the CARE assessment — our Washington care decision guide covers the complete landscape.

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