Individuals enrolled in Apple Health (Medicaid), Public Employees Benefits Board, and School Employees Benefits Board coverage - and those accessing behavioral health services - will not experience a disruption in care due to the federal government shutdown. In addition, health care providers will continue to be paid for the services they provide. We will continue to monitor the situation closely and share updates if anything changes.
To describe the Tailored Supports for Older Adults (TSOA) program and the eligibility requirements for a person to become eligible.
Effective July 1, 2017
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.
Effective June 3, 2025
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.
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.
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.
The person who receives the care must be:
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.
Certain provisions that apply to traditional long-term care services don’t apply to people who are eligible for TSOA. These include:
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.
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.
