Long-term services and supports (LTSS) manual

HCS state-funded residential program through the Medical Care Service (MCS) program

Revised Date: 
January 9, 2014

State-Funded Residential

HCS has a small state funded residential program that does not require CN eligibility. It is under the MCS medical program and state-funded payments to the provider. The functional requirements are the same as for MPC. The ACES program used is A01 or A05. This program is described in WAC 388-106-0905.

What services may I receive under state funded residential care? WAC 388-106-0900

  • Clients who meet aged, blind or disabled criteria will be opened on a new coverage group A01.
  • Clients who do not meet ABD, but meet incapacity criteria will be opened on a new coverage group A05.
  • To be eligible for A01 or A05 the client must be eligible for the HEN referral program or the ABD cash assistance program.
  • Couples who meet the 5 year bar at different times no longer need to be on a separate cash AU, as long as they both meet the ABD or incapacity criteria
  • Room and Board calculations for clients in an Adult Family Home (AFH) will no longer be calculated in ACES and notices to clients will need to be sent by social services.

Am I eligible to receive state-funded residential care services? WAC 388-106-0905

  • Lawfully present clients, not subject to the 5-year bar, who permanently reside in the US under color of law (PRUCOL) (NQ)
  • Must be eligible for ABD cash or HEN referral program
  • Only one applicant/recipient per AU
  • Scope of care is still Medical Care Services (MCS) which is state-funded
  • Used for the state-funded residential program and state-funded nursing facility program
  • Undocumented clients are NOT eligible for A01/A05 coverage

How do I approve a new A01/A05 case?

  • Applications: The client must apply for cash assistance to be able to look at the HEN/MCS eligibility
  • Washington Connection will be modified to no longer consider GA AU's as medical AU's
  • Screening: 'A' track AU's will not auto populate in screening, however the medical coverage group will be allowed as a selection in the dropdown list
  • Default will be MA/D/A01 and will switch to the correct coverage type when finalizing the AU
    • Determine if the client is an eligible noncitizen who needs LTC residential or nursing home services
    • Did the client apply for cash assistance?
    • Is the client functionally eligible for LTC services?
    • If the answer is yes to 1,2 and 3 screen in a HEN AU and an A01 AU. (Clients who are eligible for LTC services meet the incapacity criteria for HEN
    • Process the HEN AU first then finalize the A01/A05 AU
    • Determine 'durational' requirements for ABD/HEN program for clients under 65, not blind/disabled
      • Regions 1 and 3: Using barcode, complete a 14-084 referral to the CSO incapacity worker
      • Region 2: Complete a referral to the Holgate HCS social worker for a disability determination
      • Indicate on the 14-084 the following;
        • "per approved ETR to WAC 388-400-0070, HCS has approved HEN/MCS case. Client meets LTC functional requirements-disability determination is needed"
    • Notify the HCS social worker that client has been opened on HEN/MCS medical coverage so they can issue a notice to the client regarding the room and board calculation.
      • Indicate the clients current income to the social worker
    • Set a reminder to check on disability/duration with the CSO incapacity worker if applicable.

Note: GA-U/Disability lifeline ended 10/31/2011. Effective 11/1/2011 there is a Aged/Blind/Disabled (ABD) cash program and Medical coverage under state funded Medicare Care Services (MCS).

  • WAC 182-508-0005 for the state funded MCS program.
  • WAC 388-400-0060 for the ABD cash program.
  • WAC 388-513-1315 (11) which describes the ABD cash and MCS program as it applies to ADSA services.

Disability instructions for ABD are found in the EAZ social service manual.

State-Funded Long Term Care Program for Noncitizens

State-funded LTC for non citizens not eligible under ABD cash or MCS. This program is limited to 45 slots and requires a preapproved by ADSA HQ. The state-funded LTC program can be used in a nursing facility, residential or home setting.

Sandy Spiegelberg RoberSK@dshs.wa.gov 360-725-2576 HCS ADSA is the contact for preapproval of this program.

ACES instructions for ABD cash and MCS

ABD cash

MCS Medical