Tailored supports for older adults (TSOA)

Revised date
Purpose statement

To describe the Tailored Supports for Older Adults (TSOA) program and the eligibility requirements for a person to become eligible.

WAC 182-513-1610 Tailored Supports for Older Adults (TSOA) - Overview

WAC 182-513-1610 Tailored supports for older adults (TSOA) — Overview.

Effective July 1, 2017

  1. The tailored supports for older adults (TSOA) program is a federally funded program approved under section 1115 of the So­cial Security Act. It enables the medicaid agency and the agency's designees to deliver person-centered long-term services and supports (LTSS) to a person who:
    1. Meets nursing facility level of care described in WAC 388-106-0355; and
    2. Meets the functional requirements under WAC 388-106-1900 through 388-106-1990.
  2. For the purposes of TSOA, the applicant is the person receiv­ing care even though services may be authorized to the person provid­ing care. TSOA does not provide Washington apple health coverage.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1615 Tailored Supports for Older Adults (TSOA) - General Eligibility

WAC 182-513-1615 Tailored Supports for Older Adults (TSOA) - General Eligibility

Effective July 1, 2017

  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:
    1. Be age 55 or older;
    2. Be assessed as meeting nursing facility level of care under WAC 388-106-0355;
    3. Meet residency requirements under WAC 182-503-0520;
    4. Live at home and not in a residential or institutional setting;
    5. 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;
    6. Meet citizenship or immigration status requirements under WAC 182-503-0535. To be eligible for TSOA, a person must be a:
      1. U.S. citizen under WAC 182-503-0535 (1)(c);
      2. U.S. national under WAC 182-503-0535 (1)(d);
      3. Qualifying American Indian born abroad under WAC 182-503-0535 (1)(f); or
      4. Qualified alien under WAC 182-503-0535 (1)(b) and have either met or is exempt from the five-year bar requirement for medicaid.
    7. Provide a valid Social Security number under WAC 182-503-0515;
    8. Have countable resources within specific program limits under WAC 182-513-1640; and
    9. 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 they are enrolled in:
    1. Medically needy program under WAC 182-519-0100;
    2. Medicare savings programs under WAC 182-517-0300;
    3. Family planning program under WAC 182-505-0115;
    4. Family planning only programs under chapter 182-532 WAC; or
    5. The 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:
    1. Caregiver supports under medicaid alternative care (MAC) under WAC 182-513-1605; or
    2. 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:
    1. Transfer of asset penalties under WAC 182-513-1363;
    2. Excess home equity under WAC 182-513-1350;
    3. Client financial responsibility under WAC 182-515-1509;
    4. Estate recovery under chapter 182-527 WAC;
    5. Disability requirements under WAC 182-512-0050;
    6. Requirement to do anything necessary to obtain income under WAC 182-512-0700(1); and
    7. Assignment of rights and cooperation under WAC 182-503-0540

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

Clarifying Information

TSOA is a program funded under the Medicaid Transformation Project Demonstration and provides services to support unpaid caregivers in Washington State, and provides a small personal care benefit to people who don’t have an unpaid family caregiver to help them. It creates a new eligibility category and benefit package for people age 55 or older who are “at risk” of needing long-term services and supports in the future who don’t currently meet Medicaid financial eligibility criteria.

TSOA doesn’t provide health care coverage and is targeted towards people who aren’t currently eligible for medicaid. However, TSOA may be used for people who are currently only eligible for a limited scope program such as the Medicare Savings Programs, or who are only eligible for medically needy coverage.

Eligibility for TSOA is determined by reviewing the income and resources of the person (and their spouse) who receives care. The person must also be functionally eligible under WAC 388-106-1910. However, the services authorized are for the benefit of the caregiver, not the care receiver.

For example:

Joe is 85 years old and has dementia. He is being cared for by his 60 year old daughter Mary. Mary calls to apply for TSOA because Joe has started wandering and she wants to get a personal emergency response system set up to monitor Joe. She is also concerned that she doesn’t know the best way to care for Joe as his dementia worsens.

Joe is screened and meets nursing facility level of care. He meets TSOA financial eligibility criteria. Mary is approved to get a PERS unit for Joe and she is also registered to attend a local class that provides dementia education for caregivers. She is also authorized to receive respite care so someone is able to care for Joe while she attends the class.

What are the financial eligibility criteria for TSOA?

The person who receives the care must be:

  • Age 55 or older and live in a home setting
  • A Washington State resident
  • Meet the citizenship and immigration eligibility for federally funded medicaid
  • Meet NFLOC
  • Provide a valid SSN or proof of application for an SSN
  • Meet income requirements under WAC 182-513-1635
  • Meet resource requirements under WAC 182-513-1640

A person may be authorized services under the TSOA program while also applying for medicaid. However, if the person is approved for medicaid, TSOA must be closed.

What LTSS financial rules don’t apply to TSOA services?

Certain provisions that apply to traditional long-term care services don’t apply to people who are eligible for TSOA. These include:

Recovery and TEFRA liens (Chapter 182-527 WAC)

Estate Recovery doesn’t apply to services paid by the TSOA program. Likewise the state can’t establish a TEFRA lien for the cost of services provided under this program.

Worker Responsibilities

The AAA worker will notify financial staff using the 14-443 communication form when a person has been approved for TSOA services. The form will include the date services are authorized which will be used to open the T02 coverage group in ACES.

HCS financial staff are responsible for ongoing case maintenance on TSOA clients, which includes processing food assistance requests if applicable.