(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
(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; and
(f) Assignment of rights and cooperation under WAC 182-503-0540.
[Statutory Authority: RCW 41.05.021 and 41.05.160. WSR 25-15-053, s 182-513-1615, filed 7/10/25, effective 8/10/25; 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.]