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Purpose: This section describes the WAC and policy of the renewal process for long-term services and supports (LTSS) and SSI-related medical programs. Consult the Eligibility A-Z (EA-Z) manual for the eligibility review process for cash and recertification process for food benefits.
Washington Apple Health Renewals
What forms are used for Washington Apple Health LTSS renewals?
Renewals for LTSS medical can be completed:
- Online through Washington Connections. Go to "renew by benefits"; or
- By submitting DSHS 14-416 Eligibility Review for Long-Term Services and Supports (used just for SSI-related Medicaid) ; or
- By submitting DSHS 14-078 Eligibility Review (used for cash, food and SSI-related Medicaid reviews); or
- By phone. Contact the HCS Public Benefit Specialist (PBS) at the local Home and Community Service (HCS) office (link has HCS phone numbers by county).
Eligibility review forms for LTSS should be sent to:
Department of Social and Health Services
PO Box 45826
Olympia WA 98504-5826
Or FAXED to:
Department of Social and Health Services
Any document mailed or faxed to DSHS should always include a complete name and the DSHS client ID so the document is assigned to the correct case record.
First annual review when there is a Community Spouse
A phone review can be completed at the first annual review when there is a community spouse, however, it is important that verification of all resources in excess of the $2,000 resource limit are out of the institutional spouse's name and into the community spouse's name. To confirm, request asset verification system (AVS) verifications for both spouses.
Make sure the resources are document on the community spouse's screen in ACES.
At the renewal process, review eligibility elements below for LTSS. Document in remarks where changes have occurred or new information is provided.
- Resource eligibility.
- If the home or property is owned by the client, check to make sure the home or property is still in the client's name.
- Use the AVS process to verify resources for the recipient only (except at first annual review for a married couple).
- Verification of life insurance and burial plans are required at application, don't request verification at review unless a new policy is reported or if client has a whole life policy with countable cash surrender value that needs to be verified.
- Use prudent person to request verification of any questionable resources.
- Income eligibility
- Request verification of gross income at renewal only if a change is reported and there is no interface such as social security, veterans, or Washington State pension. Only request verification if the department does not have access to income verification.
- Post eligibility deductions
- Request verification of post eligibility deductions such as uncovered medically necessary expenses, guardianship fees, etc. if the client is reporting a change in the amount.
- Spousal and dependent deductions
- Request verification of spousal income and shelter costs only if the community spouse would receive a spousal allocation and changes are reported.
- Request verification of dependent income only if the dependent would receive an allocation and changes are reported.
- If doing a phone renewal it's important to document all eligibility elements including who you conducted the phone interview with and their contact information.
Worker Responsibilities - Processing Late Reviews
ALTSA gives all clients the extra time and consideration they need during the renewal process. We assure clients, representatives, case managers and facility staff all are made aware of the required eligibility review (ER) and that benefits will end if one isn't completed.
When an ER isn't initiated in ACES by mid-month, deadline alert 214 is generated. The day after alert 214 appears ACES sends a termination letter to the client and to all representatives coded in ACES to receive letters. The termination letter doesn't include another ER form and isn't sent to facilities on the institutional care facility page.
Please note: Refer to the ACES production calendar for exact dates the 214 alerts are generated.
To ensure we meet equal access (EA) service requirements for all clients:
- Initiate Washington Apple Health Medical reviews only when the following has occurred:
- Review is physically received in office; or
- Contact is made with the client, authorized representative, or guardian and
- You completed a phone interview. Document the phone review including who you talked to.
- When 214 alerts are generated for Washington Apple Health Medical:
- Review your 214 alerts,
- Contact the client, authorized representative (AREP), or guardian by the last day of the certification period. If contact is made:
- Initiate a phone renewal,
- Review all eligibility factors subject to change during the renewal process,
- Add remarks on the applicable screens, and
- Complete an asset verification system (AVS) search on known accounts.
- Send a Request for Information (0023-01) for questionable information where verification is needed or there is conflicting information. Don't ask clients to provide verification of items we're able to obtain through interfaces.
- ACES will continue to mail renewal notices for Washington Apple Health medical 45 days prior to the client's certification ends date. Completing the phone renewal is applicable when:
- Client, AREP, or guardian makes contact with your anytime during the month of review, or
- Client, AREP or guardian hasn't returned the eligibility review form and you initiate phone contact to complete the review. Please note: You don't need to wait until a 214 alert is generated to begin the phone renewal process.
- If unable to contact the client, AREP or guardian, reprint the termination letter. For Washington Apple Health medical, send the letter and an ER form with a business reply envelope to:
- The client.
- All authorized representatives, or
- The nursing facility representative (if applicable).
- If you're unable to reach the client by the 5th of the month following the certification end date for Apple Health, make a final contact with the client, AREP, or guardian by phone.
- If contact is made, reinstate, initiate the phone renewal process and send the reinstatement letter.
- If no contact is made by phone, mail an additional ER request to the client, and authorized representative.
- If the phone renewal is completed, send the recertification letter (27-04), provided services were in place during the time period the case was closed. NOTE: Clients have 30 days from the termination date to submit a completed renewal per WAC 182-504-0035.
- For cash and basic food.
The policy described above is for medical programs. Some recipients of LTSS are receiving cash and/or food benefits. Eligibility review requirements for cash assistance and recertification processes for food assistance are described in the EA-Z manual below.
- Eligibility review requirements for cash assistance are described in WAC 388-434-0005.
- Recertification process for food assistance is described in WAC 388-434-0010.