TSOA certification periods, change of circumstances and renewals
Staff will follow HCS Equal Access guidelines and provide advance and adequate notice prior to terminating a MAC or TSOA case, unless the person has passed away. If a person moves to an institutional or residential setting, the T02 AU will need to be closed in ACES. If the client requests institutional medicaid coverage and is approved, the case will be historically closed in ACES, but there is no overpayment established for TSOA services provided through the advance notice period. If the client does not apply for medicaid coverage for an institutional stay, T02 can be reopened for the remainder of the T02 financial certification period; the client cannot receive TSOA services while in the institutional or residential setting. It is the responsibility of the AAA MTD Case Manager to confirm that services are not authorized during the admission.
Example: A client is active on T02 and an SSI-related spenddown S99 (met or unmet). The client admits to a nursing facility and is admitted for 40 days. The client chooses to not apply for an institutional medicaid (L02). They plan on private paying for the nursing facility stay and use the bill to meet their spenddown liability. The T02 be reopened when the client discharges home if the discharge is within the clients original T02 financial certification period; the client should not receive a TSOA service while admitted to an institution.
Renewal notices are generated 45 days prior to the end of the certification period. When the renewal is received, review all eligibility factors and confirm with the AAA case manager whether the person is still receiving TSOA or MAC services.
If this is the first renewal, verify whether resources over the standard have been transferred to the community spouse.
For MAC clients who are only eligible for S02 coverage as a SIPI spouse under WAC 182-513-1660, verify MAC services are still being received. If not, terminate S02 coverage and redetermine the person’s eligibility under medically needy coverage if eligible.