Tailored supports for older adults (TSOA) - applications, rights, and responsibilities
Purpose: This section describes the application process for a TSOA applicant and explains a person’s rights and responsibilities.
WAC 182-513-1625 Tailored Supports for Older Adults (TSOA) — Applications.
Effective July 1, 2017
- Applications for tailored supports for older adults (TSOA) are submitted:
- Online at Washington Connection at www.washingtonconnection.org;
- By sending a completed HCA 18-008 application for TSOA form to P.O. Box 45826, Olympia, WA 98605;
- By faxing a completed HCA 18-008 application for TSOA form to 1-855-635-8305;
- By contacting your local area agency on aging (AAA) office at 1-855-567-0252; or
- By contacting your local home and community services (HCS) office. To find your local HCS office, see http://www.altsa.dshs.wa.gov/Resources/clickmap.htm.
- Help filing an application:
- The Medicaid agency or the agency's designee provides help with the application or renewal process in a manner that is accessible to people with disabilities, limitations, or other impairments as described in WAC 182-503-0120 and to those who are limited-English proficient as described in WAC 182-503-0110;
- For help filing an application:
- Contact a local AAA office;
- Contact a local HCS office;
- Have an authorized representative apply on the person's behalf.
- The following people can apply for the TSOA program:
- The applicant (the person receiving care);
- The applicant's spouse;
- The applicant's caregiver (person providing in-home caregiver services);
- A legal guardian; or
- An authorized representative, as defined in WAC 182-500-0010.
- A phone interview is required to establish TSOA financial eligibility, but may be waived if the applicant is unable to comply:
- Due to the applicant's medical condition; and
- Because the applicant does not have another person that is able to conduct the interview on the applicant's behalf.
- The agency or the agency's designee processes TSOA applications using the same timelines under WAC 182-503-0060.
- TSOA begins on the date the person is determined presumptively eligible for TSOA under WAC 182-513-1620; or on the date all eligibility requirements are established if not found presumptively eligible.
- When the person withdraws an application for TSOA, or is determined ineligible for TSOA services, the agency or the agency's designee denies the application under WAC 182-503-0080.
An application for TSOA may be submitted in several ways, either in person, by mail, by fax or online. In addition, a person may contact a Home and Community Services office by calling their local intake line, or by contacting an Area Agency on Aging (AAA) office at 1-855-567-0252.
Many people need help applying for services or Medicaid. Often there are family members or friends, or staff members of a hospital or nursing home or other agency, who are able to help. Help is also available from your local AAA and from DSHS staff, especially for people who have physical or mental impairments that make it hard to get through the application process on their own.
In order to determine if a person meets the financial eligibility criteria for the TSOA program, a person is required to have an interview. The interview may be conducted with the applicant, their spouse, authorized representative, guardian, or caregiver. If a person isn’t able to complete the interview due to the person’s medical condition, and no-one else is available to do the interview on their behalf, this requirement may be waived.
TSOA applications follow the same standard of promptness as regular medicaid applications and must be processed within 45 days, unless good cause applies.
How to request a long-term care (LTC) assessment
Call and schedule an assessment through the DSHS Central intake lines. Social Service central intake lines are divided by Regions in the State of Washington. This is used to request a social service assessment for home and community services (in-home care, care in a residential facility, nursing facility coverage).
Region 1 North
HCS-Adams, Chelan, Douglas, Ferry, Grant, Lincoln, Okanagan, Pend Oreille, Spokane, Stevens, and Whitman counties:
Region 1 South
HCS-Asotin, Benton, Columbia, Franklin, Garfield, Kittitas, Klickitat, Walla Walla, and Yakima counties. Contact the local Home and Community Service (HCS) office based on county.
Region 2 North
HCS – Island, San Juan, Skagit, Snohomish, and Whatcom, counties:
Region 2 South
HCS - King County:
HCS- Clallam, Clark, Cowlitz, Grays Harbor, Jefferson, Kitsap, Lewis, Mason, Pacific, Pierce, Thurston, and Wahkiakum Counties:
Phone: 1-800-786-3799 or 360-664-9138
WAC 182-513-1630 Tailored Supports for Older Adults (TSOA) — Rights and Responsibilities.
Effective July 1, 2017
- A person applying for or receiving tailored supports for older adults (TSOA) has the right to:
- Have TSOA rights and responsibilities explained and provided in writing;
- Be treated politely and fairly without regard to race, color, political beliefs, national origin, religion, age, gender (including gender identity and sex stereotyping), sexual orientation, disability, honorably discharged veteran or military status, or birthplace;
- Get help with the TSOA application if requested;
- Have an application processed promptly and no later than the timelines described in WAC 182-503-0060;
- Have at least ten calendar days to give the medicaid agency or the agency's designee information needed to determine eligibility and be given more time if asked for;
- Have personal information kept confidential. The agency or the agency's designee may share information with other state and federal agencies for purposes of eligibility and enrollment in other Washington apple health programs;
- Get written notice, in most cases, at least ten calendar days before the agency or its designee denies, terminates, or changes eligibility for TSOA;
- Ask for an appeal if the person disagrees with the agency or the agency's designee's decision. A person can also ask a department supervisor or administrator to review the decision or action without affecting the right to a fair hearing.
- Ask for and get interpreter or translator services at no cost and without delay.
- Ask for voter registration assistance;
Refuse to speak to an investigator if the person's case is audited. If the person does not want to let the investigator enter their home, there is no requirement to do so and the person may ask the investigator to come back at another time. Such a request will not affect a person's eligibility for TSOA; and
Get equal access services under WAC 182-503-0120 if eligible.
An applicant or recipient of TSOA is responsible to:
Report changes in household or family circumstances as required under WAC 182-513-1650;
Provide the agency or the agency's designee with any information or proof needed to determine eligibility. If the person has trouble getting proof, the agency or the agency's designee helps get the proof needed or contacts other persons or agencies for it;
Provide a valid Social Security number or immigration document number in order to verify identity, citizenship, immigration status, date of birth, and whether the person has other health care coverage. This information is not shared with the department of homeland security;
Complete renewals when requested; and
Cooperate with quality assurance when requested.
TSOA doesn’t provide health care coverage, therefore, many of the requirements under Apple Health don’t apply to TSOA applicants and recipients. However, the same client rights do apply, including hearing rights full TSOA determinations.