Applications for LTSS

Clarifying Information

What is the best way to apply for LTSS?

Applications for LTSS may be submitted using any of the following methods:

• Apply online at: www.WashingtonConnection.org
  If the client applies using the Washington Connection website the application will be assigned to a Home & Community Services office. This is not a real-time eligibility process.
• Apply online at www.wahealthplanfinder.org.
  • Applications submitted through this site will have a real-time determination of Washington Apple Health medical coverage eligibility under the modified adjusted gross income (MAGI) methodology. If a client is 65 or over or on Medicare, their eligibility is not done in real time and they will be redirected to the WashingtonConnection.org link to complete the application process.
  • To apply for LTSS through this site, the client must indicate a need for LTSS in the Additional Questions screen in the Healthplanfinder application. The client should then click the link at the end of the application access Washington Connection and apply for LTSS (you may want to start the application here).
• Apply by completing the HCA 18-005 Washington Apple Health Application for Aged, Blind, Disabled/Long-Term Care coverage and mail or fax into HCS, or
• Apply by completing the HCA 18-008 Washington Apple Health for Tailored Supports for Older Adults (TSOA), which is a program that provides supports to caregivers, or
• Apply in-person at a local Home & Community Services office. To find an HCS office near you, check at www.altsa.dshs.wa.gov/Resources/clickmap.htm, or
• Call the HCS intake line in the area in which you reside to schedule an assessment. See "How to request an LTSS assessment" below.

Mailing or faxing documents to Home and Community Services (HCS)

Mail to:
Home and Community Services - LTSS Services
PO Box 45826
Olympia WA 98504-5826; or
FAX to: 1-855-635-8305

Always include the client's full case name and the DSHS client id (if known) on any document mailed or faxed to DSHS.

How to request a LTSS assessment: 

Call and request an assessment through the HCS central intake lines. The social service central intake lines are divided by regions and are used to request an assessment for home and community services (in-home care, care in a residential facility, nursing facility coverage).

Region 1 HCS: Pend Oreille, Stevens, Ferry, Okanogan, Chelan, Douglas, Grant, Lincoln, Spokane, Adams, Klickitat, Yakima, Benton, Franklin, Walla Walla, Columbia, Garfield, Asotin and Whitman Counties: 1-509-568-3767 or 1-866-323-9409 or FAX 509-575-2286

Region 1 South HCS: Klickitat, Kittitas, Yakima, Benton, Franklin, Walla Walla, Columbia, Garfield and Asotin Counties: 1-509-568-3767 or FAX 509-575-2286

Region 2 North HCS: Snohomish, Whatcom, Skagit, Island Counties: 1-800-780-7094 or FAX 425-977-6579

Region 2 South HCS: King county: 206-341-7750 or fax 206-373-6855

Region 3 HCS: Pierce, Kitsap, Thurston, Mason, Lewis, Grays Harbor, Pacific, Cowlitz, Clark, Clallam, Jefferson Counties: 1-800-786-3799 or fax 1-855-635-8305   

What if the applicant for LTSS is already on Washington Apple Health?

1. A new application is not required for clients active on Aged, Blind, Disabled (ABD) SSI-related Apple Health who need LTSS as long as the Public Benefit Specialist (PBS) is able to determine institutional eligibility using information in the current case record. Examples are the SSI or SSI-related programs or Apple Health for Workers with Disabilities (HWD). Use the original eligibility review date to open institutional coverage. Center for Medicare and Medicaid Services (CMS) requires an annual review at least once a year for categorically needy (CN) Medicaid.
2. Review excess home equity, annuity and transfer of resource provisions that are specific to institutional and home and community-based waivers.
3. SSI recipients who need institutional services, or HCB waiver, must complete and sign an application, or the DSHS 14-416 Eligibility Review for Long-Term Care Benefits. Do not hold up eligibility for long-term care awaiting a signed review. If an application, eligibility review or LTSS review is in the electronic case record within that past year, a new review form is not needed.
4. Ensure an Asset Verification System (AVS) Authorization is on file, and if not, follow these procedures. 

LTSS applications for clients on MAGI-based Washington Apple Health

A client that is active on Modified Adjusted Gross Income (MAGI) medical (N track in ACES, with the exception of AEM N21 and N25), needing nursing facility long-term care services, Community First Choice (CFC), or Medicaid Personal Care (MPC) don't need to submit an additional application. MAGI medical coverage is determined through the Health Benefit Exchange (HBE), not DSHS; and includes nursing facility care, CFC, and MPC within the benefit package for those functionally eligible for the service.

If the client needs services waiver services they must submit an application and may need a disability determination.

Other useful information

The following links have additional information about applying for LTSS programs, Estate Recovery requirements and applying online through Washington Connection:

• LTC overview gives a description of programs
• Information about Medicaid and Estate Recovery
• When should one file an application for long-term service and support coverage?

Clarifying Information

Documenting standard of promptness for all medical applications that are pending for 45 days or more:

• "NG" or no delayed reason code will show up on the 45 day list to the DSHS secretary.
• A good cause code must be used when opening any medical assistance unit (MAU) historically beyond a 45 day time frame including program changes.
• A good cause code must be used when doing a program change from one medical program to another to prevent the assistance unit from appearing to be as a new application. If good cause is not indicated, a program change will appear to be a new application.
• Day one is the day after the date the application was received. 

See management bulletin: H13-057 - Policy/Procedure

Clarifying information

If an applicant has withdrawn their request for medical benefits and decides they want to pursue the application, we will redetermine eligibility for benefits without a new application as long as the client has notified the department within 30 days of the withdrawal. The PBS would need to review the original application to ensure there are no changes and proceed to determine eligibility.

Forms used in the application process

The application process begins and the application date is established when the request for benefits is received. These are the forms used in the application process for LTSS.

HCA forms, including translations are found on the HCA forms website.

DSHS forms, including translations are found on the DSHS forms website.

HCA 18-003 Rights and responsibilities (translations can be found at Health Care Authority (HCA) forms under 14-113)

HCA 18-005 Washington Apple Health application for aged, blind, disabled/long-term care coverage

HCA 18-008 Washington Apple Health application for tailored supports for older adults (TSOA)

DSHS 14-001 Application for cash or food assistance. This is used for any cash, food or medical care services (MCS) request as MCS is tied to ABD cash/HEN eligibility

HCA 14-194 Medical coverage information (used to report third party insurance coverage including LTC insurance)

DSHS 14-539 Revocable burial fund provision for SSI-related health care

DSHS 14-540 Irrevocable burial fund provision for SSI-related health care

DSHS 14-454 Estate recovery fact sheet. Repaying the state for medical and long-term services and supports 

DSHS 14-501 Community resource declaration (used to evaluate resources (assets) for an applicant and their spouse based on date of institutionalization. WAC 182-513-1350)

DSHS 14-532 Authorized representative release of information.

DSHS 10-438 Long-term care partnership (LTCP) asset designation form (used to designate assets (resources) for those with a long-term care partnership insurance policy)

DSHS 14-012 Consent (release of information form) (used for all DSHS programs)

Note: The HCA 80-020 Authorization for Release of Information is for medical benefits under Health Care Authority and will be accepted as a release of information for all medical programs including LTSS programs. The DSHS consent form is preferred as it is used for all programs including medical, food and cash.

The long-term service and support application process - who makes the eligibility determinations

PBS determines financial eligibility by comparing the client's income, resources and circumstances to program criteria. The PBS also determines client responsibility.

Social service staff and case managers determine functional eligibility and what services to authorize based on a complete and comprehensive care assessment. 

Both functional and financial eligibility are done at the same time. When a client is found both financially eligible and functionally eligible for LTSS and an approved provider is in place, then LTSS can begin.

What is the process for nursing facility care?

For aged/blind/disabled, SSI-related Washington Apple Health programs:

1. Department-designated social service staff:
   1. Assess the client's functional eligibility for institutional care.
   2. Screen all clients to determine potential for home and community services.
   3. Determine if the client is likely to attain institutional status as described in WAC 182-513-1320. (will the client be likely to reside at the nursing facility for 30 days or longer?) Notify the facility when the client doesn't appear to meet the need for nursing facility (NF) care.
   4. Determine if a housing maintenance allowance (HMA) is appropriate. 
   5. Provide PBS staff with the following information:
      1. Date of NF admission
      2. Whether the client meets nursing facility level of care (NFLOC)
      3. For medicaid recipients, the first date DSHS was notified of the admission by the nursing facility
      4. If the client is likely to attain institutional status 
      5. The amount of housing maintenance allowance and the start date if appropriate.
2. Public benefit specialist (PBS) staff:
   1. Refer the client to the soical worker for a care assessment if the client contacts the PBS first and document the date the client first requested NF care.
   2. Determine the client's financial eligibility for LTSS and noninstitutional medical assistance including 3 months retroactive medical coverage if financially eligible.
   3. Authorize payment for NF care if the client is both functionally and financially eligible.
      1. For medicaid applicants, institutional services are approved based on the date the client is eligible up to 3 months prior to the date of application.
      2. For medicaid recipients, institutional services are approved based on the first date the admission is known to DSHS as long as the client meets all other eligibility factors. If the NF admission is on a weekend or holiday, the NF has until the first business day to report the admission.
   4. Issue the NF award letter to the applicant/recipient and the nursing facility.

What is the process of in-home or residential waiver services?

This process applies to aged/blind/disabled SSI-related programs only – MAGI-based clients are not eligible for HCBS waiver.

1. Department-designated social service staff:
   1. Assess the client's functional eligibility for in home or residential care.
   2. Provide the PBS staff with the following information:
      1. Service start date
      2. Type of service 
      3. Residential facility name and address
2. Financial services staff:
   1. Refer the client to the social worker for a care assessment if the client contacts the PBS first and document the date the client first requested in home or residential care.
   2. Give a projected client responsibility amount to the social worker using the LTSS referral 07-104. Clearly indicate this is a projection and the financial application is in process.
   3. Determine the client's financial eligibility for LTSS medicaid and/or noninstitutional medical assistance including a request for retro medical if needed.
   4. Authorize in ACES for in home or residential Waiver if the client is both functionally and financially eligible.
   5. Issue the award letter to the applicant/recipient.

Note: Services can't be backdated prior to the date of the authorization.

Clients switching from private pay to medicaid are advised to apply for benefits 30 to 45 days before being resource eligible for the program. There is good information on the Washington LawHelp site that explains the timing of an LTSS application.

What is the best practice guidelines for fast track?

Fast Track is a social services process that allows the authorization of LTSS prior to a financial eligibility determination. Social services makes this determination by consulting the PBS who can reasonably conclude the client will likely be financially eligible.

Clients receiving services during the fast track period won’t receive a medical services card until financial eligibility is established. Services may be authorized using fast track for a maximum of 90 days.

Always attempt to contact the client or representative to conduct an interview prior to considering Fast Track so you have as much information as possible before making Fast Track decision. If you are unable to make contact, you should still make a Fast Track determination based on the information and verifications that you have available, and send this determination via 07-104 to social services after your first contact attempt.

Questions to consider if a client is likely eligible for Fast Track before an interview is completed:

1. What resources is the client reporting on the application or past applications?
2. Are transfers indicated?
3. Did you receive verification of resources with the application?
4. Have you received Accurint results and reviewed the assets reported?
5. Is the client married or single? (don’t forget about spousal resource limits)

A Fast Track consideration can vary case-by-case based on the types of resources discovered during the interview and the client’s current circumstances. 

Social services can’t begin fast track until a care assessment is completed. The determination of fast track is ultimately up to social services. 

Don’t open a case in ACES just because you have received a fast track agreement unless you have everything needed to establish financial eligibility.

If the client ends up not being financially eligible for services, notify social services. An overpayment is not established.  Social services would need to state fund fast Track services when the client is found not financially eligible during the fast track period.