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Applications for LTSS
Purpose: This section describes the application processes used by Aging and Long-term Supports Administration (ALTSA) when determining financial eligibility for Long-Term Services and Supports (LTSS).
How to Apply
The PBS will:
- Complete a Financial Communication to Social Services (07-104) referral when an application is received on an active MAGI case
- Add text stating that unless an assessment is completed and determines HCB Waiver is needed, the client will remain on MAGI
- Send a general correspondence letter to the client indicating the application was received and because the client is currently receiving Medicaid services, additional information isn't needed for financial eligibility.
NOTE: If an 18-005 is received on an active MAGI case and the client is in a NF or Hospice care center, no action is needed by the PBS. MAGI covers NF and Hospice under the scope of care. Exception is N21/N25 AEM MAGI.
The interview can be conducted in person or by phone. Call the client or their representative to complete an interview. If they can't be reached, or are unavailable, send an appointment letter (DSHS 0011-01) and a request for verification letter for what is needed to determine eligibility, based only on what was declared on the application.
The PBS must:
- Go over the application, particularly what was declared in the income and resource sections. Ask about other resources not declared on the application. General open-ended questions about resources and income should also be asked. Family members and other representatives are often just learning about the client's income and resources when they apply. Open-ended questions often reveal that additional sources of income and assets may exist.
- Document in ACES remarks, in detail, all eligibility factors discussed during the interview and included on the application.
- If not already authorized, request authorization for AVS for the client and any applicable financially responsible people. Ensure AVS procedures are followed.
- Ask about any transfers, gifts, or property sales during the 5-year look back and the circumstances of why they were made. Request verification of transfers, gifts or property sales, if applicable.
- Ask about other medical coverage. If there is other medical coverage and you can obtain the information during the interview, complete a 14-194 medical coverage form in Barcode.
- Ask if there are unpaid medical expenses and request verification if medical expenses exist. Ask if any of these bills were incurred within the last 3 months.
- Explain the financial and social service functional eligibility process. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility.
- For in-home service applicants, discuss the food assistance program and inquire if the household would like to apply for food benefits.
- Explain the medical service card, automatic Medicare D enrollment if not on a creditable coverage or Medicare D Prescription Drug Plan.
- Explain the Medicare Savings Program (MSP). If the applicant is eligible for an MSP based on income and resource guidelines and all information is received to determine eligibility for MSP, don't hold up processing this program while the LTSS medical is pending.
- Explain participation and room and board, how the amount is determined, and that it must be paid to the provider.
- Explain Estate Recovery and mail the Estate Recovery fact sheet.
- Explain what changes of circumstances need to be reported
- In the case of the community spouse, explain how all resources in excess of the $2,000 resource limit must be transferred to the spouse within 1 year and the requirement to provide verification of this by the first annual review.
- Summarize what verification is needed to complete the application and send a request for information letter. Encourage the applicant to gather documents as soon as possible to expedite the process. Explain how to request an extension if more time is needed.
- Summarize the interview and items still needed to determine eligibility in the ACES narrative.
- Type of client interaction (phone, in-person, etc.)
- Statements made by the client and/or their representative.
- Case actions and why the actions were taken, and
- Eligibility decisions made, or next steps.
- When working on a case that has ACES Equal Access (EA) requirements:
- Document how the plan was followed,
- If changing ACES EA requirements, clearly document the reason.
Use Remarks to document information specific to the ACES page:
- Details of how eligibility factor(s) were verified,
- When using Collateral Contact (CC) or Other (OT) valid value, document the details of how it was verified,
- When information is verified using an electronic source (such as BENDEX, AVS, etc.),
- Include Remarks to reconcile any discrepancies, or important information not otherwise captured, including required questions left blank on the application or eligibility review form.
- An ongoing permanent history of actions and decisions made;
- A support of eligibility, ineligibility and benefit determination;
- Credibility for decisions when used as evidence in legal matters;
- A trail for reviewers to determine the accuracy of the benefits issued.
Follow these principles when documenting:
- Clear - Use readily understood language.
- Acronyms utilized should be DSHS/HCA approved
- Concise - Documentation is subject to public review. Stick to the facts relevant to determining eligibility or benefit level.
- Complete - The documentation must support the eligibility decision and allow a reviewer to determine what was done and why.
- Consistent - Explain how conflicts or inconsistencies of information were addressed. Demonstrate the reasonableness of decisions. Ensure what you document accurately describes what happened with the case.