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PDFWAC 182-513-1615

Tailored supports for older adults (TSOA)General eligibility.

(1) The person receiving care must meet the financial eligibility criteria for tailored supports for older adults (TSOA).
(2) To be eligible for the TSOA program, the person receiving care must:
(a) Be age 55 or older;
(b) Be assessed as meeting nursing facility level of care under WAC 388-106-0355;
(c) Meet residency requirements under WAC 182-503-0520;
(d) Live at home and not in a residential or institutional setting;
(e) Have an eligible unpaid caregiver under WAC 388-106-1905, or meet the criteria under WAC 388-106-1910 if the person does not have an eligible unpaid caregiver;
(f) Meet citizenship or immigration status requirements under WAC 182-503-0535. To be eligible for TSOA, a person must be a:
(i) U.S. citizen under WAC 182-503-0535 (1)(c);
(ii) U.S. national under WAC 182-503-0535 (1)(d);
(iii) Qualifying American Indian born abroad under WAC 182-503-0535 (1)(f); or
(iv) Qualified alien under WAC 182-503-0535 (1)(b) and have either met or is exempt from the five-year bar requirement for medicaid.
(g) Provide a valid Social Security number under WAC 182-503-0515;
(h) Have countable resources within specific program limits under WAC 182-513-1640; and
(i) Meet income requirements under WAC 182-513-1635.
(3) TSOA applicants who receive coverage under Washington apple health programs are not eligible for TSOA, unless their enrollment is limited to the:
(a) Medically needy program under WAC 182-519-0100;
(b) Medicare savings programs under WAC 182-517-0300;
(c) Family planning program under WAC 182-505-0115;
(d) Family planning only programs under chapter 182-532 WAC; or
(e) Kidney disease program under chapter 182-540 WAC.
(4) A person who receives apple health coverage under a categorically needy (CN) or alternative benefit plan (ABP) program is not eligible for TSOA but may qualify for:
(a) Caregiver supports under medicaid alternative care (MAC) under WAC 182-513-1605; or
(b) Other long-term services and supports under chapter 182-513 or 182-515 WAC.
(5) The following rules do not apply to services provided under the TSOA benefit:
(a) Transfer of asset penalties under WAC 182-513-1363;
(b) Excess home equity under WAC 182-513-1350;
(c) Client financial responsibility under WAC 182-515-1509;
(d) Estate recovery under chapter 182-527 WAC;
(e) Disability requirements under WAC 182-512-0050;
(f) Requirement to do anything necessary to obtain income under WAC 182-512-0700(1); and
(g) Assignment of rights and cooperation under WAC 182-503-0540.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 23-11-007, § 182-513-1615, filed 5/4/23, effective 6/4/23. Statutory Authority: RCW 41.05.021, 41.05.160, 2016 1st sp.s. c 36 § 213 (1)(e), section 1115 of the Social Security Act, and 42 C.F.R. §§ 431.400 through 431.428. WSR 17-12-019, § 182-513-1615, filed 5/30/17, effective 7/1/17.]
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