Tailored supports for older adults (TSOA) presumptive eligibility
Purpose: This section describes how the presumptive eligibility process works.
WAC 182-513-1620 Tailored Supports for Older Adults (TSOA) - Presumptive Eligibility
WAC 182-513-1620 Tailored Supports for Older Adults (TSOA) - Presumptive Eligibility (PE).
Effective May 29, 2021
- A person may be determined presumptively eligible for tailored supports for older adults (TSOA) services upon completion of a prescreening interview.
- The prescreening interview may be conducted by either:
- The area agency on aging (AAA); or
- By a home and community services intake case manager or social worker.
- To receive services under presumptive eligibility (PE), the person must meet:
- The presumptive period begins on the date the determination is made and:
- Ends on the last day of the month following the month of the presumptive eligibility (PE) determination if a full TSOA application is not completed and submitted by that date; or
- Continues through the date the final TSOA eligibility determination is made if a full TSOA application is submitted before the last day of the month following the month of the PE determination.
- If the person applies and is not determined financially eligible for TSOA, there is no overpayment or liability on the part of the applicant for services received during the PE period.
- The medicaid agency or the agency's designee sends written notice as described in WAC 182-518-0010 when PE for TSOA is approved or denied.
- A person may receive services under presumptive eligibility only once within a twenty-four-month period.
- If the department of social and health services establishes a waitlist for TSOA services under WAC 388-106-1975, PE does not apply.
The PE process is determined and authorized by the AAA and HCS social services staff. Unlike Fast Track, financial staff don’t need to send a 07-104 communication to the authorizing case manager, approving PE.
For MAC: PE is only authorized for people who are currently eligible for CNP or ABP coverage, therefore the PE determination is only for the functional eligibility criteria. Staff should document the PE approval in the person’s case. If NFLOC is approved and MAC services are authorized, HCS will need to transfer the medicaid case into their HCS office to manage.
For TSOA: The PE determination may be for both functional and financial eligibility criteria. In most cases, the TSOA applicant will not be eligible for medicaid so the HCS financial worker doesn’t need to do anything at the time of the PE approval. Once a TSOA application is received and a case is screened into ACES, the worker should document that PE was authorized and send the case manager a 07-104 communication notifying them that the application was filed so that the PE authorization period can be extended until the application is processed. There is no requirement to open T02 coverage in months prior to the application month to cover the PE period.
Once the TSOA application is approved or denied, send another 07-104 communication to the case manager to notify them of the final decision.
Note: If the PE determination is made by AAA staff, the worker must select the correct AAA location in Barcode in order to send the 07-104 form to AAA staff responsible for the Medicaid Transformation Project, and not to AAA Medicaid Case Management staff.