WAC 182-505-0100 Monthly income standards for MAGI-based programs.

WAC 182-505-0100 Monthly income standards for MAGI -based programs.

Effective November 1, 2024.

  1. Each year, the federal government publishes new federal poverty level (FPL) income standards in the Federal Register found at https://aspe.hhs.gov/poverty-guidelines.
    1. The income standards for the following Washington apple health programs change on the first day of April every year based on the new FPL, except for subsections (2) and (3) of this section.
    2. The agency determines income eligibility by comparing countable income as determined of the person's medical assistance unit (MAU), under WAC 182-506-0010 and 182-506-0012, to the applicable income standard. Rules for determining countable income are in chapter 182-509 WAC.
  2. Parents and caretaker relatives under WAC 182-505-0240 must have countable income equal to or below the following standards:
    Medical Assistance Unit Size 1 2 3 4 5 6 7 8 9 10 11+
    Medical Assistance Unit Size $511 $658 $820 $972 $1,127 $1,284 $1,471 $1,631 $1,792 $1,951 $1,951
  3. Parents and caretaker relatives with earned income above the limits in subsection (2) of this section are the only people who may be eligible for the transitional medical program described in WAC 182-523-0100.
  4. Adults described in WAC 182-505-0250 who are not eligible under subsection (2) or (3) of this section must have countable income equal to or below 133 percent of the FPL.
  5. Pregnant people described in WAC 182-505-0115 must have countable income equal to or below 210 percent of the FPL.
  6. Children with countable income:
    1. Equal to or below 210 percent of the FPL as described in WAC 182-505-0210 (3)(a)(i) receive coverage at no cost.
    2. Greater than 210 percent but equal to or less than 312 percent as described in WAC 182-505-0210 receive premium-based coverage. Premium amounts are described in WAC 182-505-0225.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

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WAC 182-513-1660 Medicaid Alternative Care (MAC) and Tailored Supports for Older Adults (TSOA) - Spousal Impoverishment

WAC 182-513-1660 Medicaid alternative care (MAC) and tailored supports for older adults (TSOA)—Spousal impoverishment.

Effective February 25, 2023

  1. The medicaid agency or the agency's designee determines financial eligibility for medicaid alternative care (MAC) or tailored supports for older adults (TSOA) using spousal impoverishment protections under this section, when an applicant or recipient:
    1. Is married to, or marries a person not in a medical institution; and
    2. Is ineligible for a noninstitutional categorically needy (CN) SSI-related program or the TSOA program due to:
      1. Spousal deeming rules under WAC 182-512-0920 for MAC;
      2. Exceeding the resource limit in WAC 182-512-0010 for MAC, or the limit under WAC 182-513-1640 for TSOA; or
      3. Both (b)(i) and (ii) of this subsection.
  2. When a resource test applies, the agency or the agency's designee determines countable resources using the SSI-related resource rules under chapter 182-512 WAC, except pension funds owned by the spousal impoverishment protections community (SIPC) spouse are not excluded as described under WAC 182-512-0550:
    1. Resource standards:
      1. For MAC, the resource standard is $2,000; or
      2. For TSOA, the resource standard is $53,100.
    2. Before determining countable resources used to establish eligibility for the applicant, the agency or the agency's designee allocates the state spousal resource standard to the SIPC spouse.
    3. The resources of the SIPC spouse are unavailable to the spousal impoverishment protections institutionalized (SIPI) spouse the month after eligibility for MAC or TSOA services is established.
  3. The SIPI spouse has until the end of the month of the first regularly scheduled eligibility review to transfer countable resources in excess of $2,000 (for MAC) or $53,100 (for TSOA) to the SIPC spouse.
  4. Income eligibility:
    1. For MAC:
      1. The agency or the agency's designee determines countable income using the SSI-related income rules under chapter 182-512 WAC, but uses only the applicant or recipient's income;
      2. If the applicant's or recipient's countable income is at or below the SSI categorically needy income level (CNIL), the applicant or recipient is considered a SIPI spouse and is income eligible for noninstitutional CN coverage and MAC services;
    2. For TSOA, see WAC 182-513-1635.
  5. Once a person no longer receives MAC services, eligibility is redetermined without using spousal impoverishment protections under WAC 182-504-0125.
  6. If the applicant's separate countable income is above the standards described in subsection (4) of this section, the applicant is not income eligible for MAC or TSOA services.
  7. The spousal impoverishment protections described in this section are time-limited for MAC clients and expire on September 30, 2027.
  8. Standards described in this chapter are located at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1655 Tailored Supports for Older Adults (TSOA) - Renewals.

WAC 182-513-1655 Tailored supports for older adults (TSOA) — Renewals.

Effective July 1, 2017

  1. A person who receives tailored supports for older adults (TSOA) services must complete a renewal of all eligibility factors for the program at least every twelve months.
  2. Forty-five days prior to the end of the certification period, notice is sent with the HCA 18-008 application for TSOA form. Complete the TSOA renewal in any of the following ways:
    1. Complete the TSOA application form, sign it, and mail it to P.O. Box 45826, Olympia, WA 98605 by the due date on the letter;
    2. Complete the TSOA application form, sign it, and fax it to 1-855-635-8305 by the due date on the letter;
    3. Renew online at Washington connection at https://www.washingtonconnection.org by the due date on the letter; or
    4. Call your local home and community services office at the telephone number on the letter by the due date on the letter.
  3. During the renewal process, the medicaid agency or the agency's designee reviews all eligibility factors to determine ongoing eligibility for TSOA, and may request additional verification of eligibility factors under WAC 182-503-0050 if unable to verify information through existing data sources. If additional information is needed, the agency or the agency's designee sends written notice under WAC 182-518-0015.
  4. If the agency or the agency's designee is unable to complete the renewal or determine eligibility for TSOA beyond the certification period, prior to ending eligibility for TSOA, the agency or the agency's designee sends a written termination notice as described in WAC 182-518-0025.
  5. A person who is terminated from TSOA for failure to renew has thirty days from the termination date to submit a completed renewal. If still eligible, TSOA is reopened without a break in eligibility.
  6. Equal access services as described in WAC 182-503-0120 are provided for anyone who needs help meeting the requirements of this section.
  7. Anyone who disagrees with an action regarding TSOA eligibility may ask for a hearing under chapter 182-526 WAC.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1650 Tailored Supports for Older Adults (TSOA) - Changes of Circumstances Requirements.

WAC 182-513-1650 Tailored Supports for Older Adults (TSOA) — Changes of Circumstances Requirements.

Effective July 1, 2017

  1. Changes in tailored supports for older adults (TSOA) household and family circumstances described in subsection (2) of this section must be reported to the medicaid agency or the agency's designee within thirty days of the date of the change.
  2. The following changes must be reported:
    1. A change in residential or mailing address, including if the TSOA recipient moves out-of-state;
    2. When a person admits to an institution, as defined in WAC 182-500-0050, and is likely to reside there for thirty days or longer; or
    3. The person dies.
  3. Effective date is the date of the changes.
    1. When TSOA terminates because the recipient dies, the effective date is the date of death.
    2. When TSOA terminates because of one of the following reasons, the effective date is the first day of the month following the advance notice period described in subsection (4) of this section. The TSOA recipient:
      1. Is admitted to an institution as defined in WAC 182-503-0050, and is expected to reside there for thirty days or longer;
      2. Is approved for coverage under a home and community-based waiver program;
      3. No longer meets nursing facility level of care under WAC 388-106-0355; or
      4. Becomes eligible for categorically need (CN) or alternative benefits plan (ABP) apple health coverage. The recipient may continue to receive authorized services through the medical alternative care (MAC) program under WAC 182-513-1600. The person may also apply for other long-term services and supports available under chapters 182-513 and 182-515 WAC.
  4. The advance notice period:
    1. Begins on the day the letter about the change is mailed; and
    2. Is determined according to the rules in WAC 182-518-0025.
  5. When the law or regulation is the effective date of the change.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1645 Tailored Supports for Older Adults (TSOA) - Certification Periods.

WAC 182-513-1645 Tailored supports for older adults (TSOA) — Certification periods.

Effective July 1, 2017

  1. A certification period is the period of time a person is determined eligible for the tailored supports for older adults (TSOA) program. It begins on the first day of the month that the medicaid agency or the agency's designee determines the person is eligible for TSOA services, and continues through the last day of the month of the certification period.
  2. TSOA is certified for twelve months of continuous coverage regardless of a change in circumstances, unless the person:
    1. Moves out-of-state;
    2. Meets institutional status under WAC 182-513-1320;
    3. Becomes eligible for a categorically needy or alternate benefit plan Washington apple health program; or
    4. Dies.
  3. Financial eligibility for the TSOA program may not be approved prior to the date of a presumptive or full eligibility determination.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1640 Tailored Supports for Older Adults (TSOA) - Resource Eligibility

WAC 182-513-1640 Tailored supports for older adults (TSOA) — Resource eligibility.

Effective October 9, 2023

  1. The resource standard for a single applicant for tailored supports for older adults (TSOA) is six times the Washington state average monthly private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW.
  2. The resource standard for a married couple is six times the Washington state average monthly private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW, for the TSOA applicant plus the state spousal resource standard for the spousal impoverishment protections community (SIPC) spouse. The state spousal resource standard may change annually on July 1st.
  3. The medicaid agency or the agency's designee uses rules in WAC 182-513-1350 (1), (3) and (4) to determine general eligibility relating to resources, availability of resources, and which resources count.
  4. The TSOA recipient has one year from the date of initial eligibility of TSOA to transfer resources in excess of the TSOA standard to the SIPC spouse.
  5. The resource standard for TSOA changes annually on January 1st based on the current average private nursing facility rate, as determined by the department of social and health services under chapter 74.46 RCW.
  6. The current TSOA standards and the current average private nursing facility rate are found on the Washington apple health income and resource standards chart, institutional standards section; see www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1635 Tailored Supports for Older Adults (TSOA) - Income Eligibility

WAC 182-513-1635 Tailored Supports for Older Adults (TSOA) — Income Eligibility.

Effective October 6, 2023

  1. To determine income eligibility for the tailored supports for older adults (TSOA) program, the medicaid agency or the agency's designee uses the following rules depending on whether the person is single or married.
  2. If the TSOA applicant is single:
    1. Determine available income under WAC 182-513-1325;
    2. Exclude income under WAC 182-513-1340; and
    3. Compare remaining gross nonexcluded income to 400 percent of the federal benefit rate (FBR) for the supplemental security income (SSI) cash grant program. To be eligible, a person's gross income must be equal to or less than 400 percent of the FBR.
  3. If the TSOA applicant is married, the agency or the agency's designee:
    1. Determines available income under WAC 182-513-1330 with the exception of subsections (5) and (6) of that section;
    2. Exclude income under WAC 182-513-1340;
    3. Compare the applicant's remaining gross nonexcluded income to 400 percent of the FBR. To be eligible, a person's gross income must be equal to or less than 400 percent of the FBR.
  4. The FBR changes annually on January 1st.
  5. The current TSOA income standard is found on the Washington apple health income and resource standards chart, institutional standards section; see www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1630 Tailored Supports for Older Adults (TSOA) - Rights and Responsibilities

WAC 182-513-1630 Tailored Supports for Older Adults (TSOA) — Rights and Responsibilities.

Effective July 1, 2017

  1. A person applying for or receiving tailored supports for older adults (TSOA) has the right to:
    1. Have TSOA rights and responsibilities explained and provided in writing;
    2. 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;
    3. Get help with the TSOA application if requested;
    4. Have an application processed promptly and no later than the timelines described in WAC 182-503-0060;
    5. 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;
    6. 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;
    7. Get written notice, in most cases, at least ten calendar days before the agency or its designee denies, terminates, or changes eligibility for TSOA;
    8. 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.
    9. Ask for and get interpreter or translator services at no cost and without delay.
    10. Ask for voter registration assistance;
    11. 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
    12. Get equal access services under WAC 182-503-0120 if eligible.
  2. An applicant or recipient of TSOA is responsible to:
    1. Report changes in household or family circumstances as required under WAC 182-513-1650;
    2. 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;
    3. 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;
    4. Complete renewals when requested; and
    5. Cooperate with quality assurance when requested.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

WAC 182-513-1625 Tailored Supports for Older Adults (TSOA) - Applications.

WAC 182-513-1625 Tailored Supports for Older Adults (TSOA) — Applications.

Effective October 9, 2023

  1. Applications for tailored supports for older adults (TSOA) are submitted:
    1. Online at Washington Connection at www.washingtonconnection.org;
    2. By sending a completed HCA 18-005 application for TSOA form to P.O. Box 45826, Olympia, WA 98605;
    3. By faxing a completed HCA 18-005 application for TSOA form to 1-855-635-8305;
    4. By contacting your local area agency on aging (AAA) office at 1-855-567-0252; or
    5. By contacting your local home and community services (HCS) office. To find your local HCS office, see https://www.dshs.wa.gov/ALTSA/resources.
  2. Help filing an application:
    1. 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;
    2. For help filing an application:
      1. Contact a local AAA office;
      2. Contact a local HCS office;
      3. Have an authorized representative apply on the person's behalf.
  3. The following people can apply for the TSOA program:
    1. The applicant (the person receiving care);
    2. The applicant's spouse;
    3. The applicant's caregiver (person providing in-home caregiver services);
    4. A legal guardian; or
    5. An authorized representative, as defined in WAC 182-500-0010.
  4. A phone interview is required to establish TSOA financial eligibility, but may be waived if the applicant is unable to comply:
    1. Due to the applicant's medical condition; and
    2. Because the applicant does not have another person that is able to conduct the interview on the applicant's behalf.
  5. The agency or the agency's designee processes TSOA applications using the same timelines under WAC 182-503-0060.
  6. 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.
  7. 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.

This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.

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