Clarifying Information

TSOA is a program funded under the Medicaid Transformation Project Demonstration and provides services to support unpaid caregivers in Washington State, and provides a small personal care benefit to people who don’t have an unpaid family caregiver to help them. It creates a new eligibility category and benefit package for people age 55 or older who are “at risk” of needing long-term services and supports in the future who don’t currently meet Medicaid financial eligibility criteria.

TSOA doesn’t provide health care coverage and is targeted towards people who aren’t currently eligible for medicaid. However, TSOA may be used for people who are currently only eligible for a limited scope program such as the Medicare Savings Programs, or who are only eligible for medically needy coverage.

Eligibility for TSOA is determined by reviewing the income and resources of the person (and their spouse) who receives care. The person must also be functionally eligible under WAC 388-106-1910. However, the services authorized are for the benefit of the caregiver, not the care receiver.

For example:

Joe is 85 years old and has dementia. He is being cared for by his 60 year old daughter Mary. Mary calls to apply for TSOA because Joe has started wandering and she wants to get a personal emergency response system set up to monitor Joe. She is also concerned that she doesn’t know the best way to care for Joe as his dementia worsens.

Joe is screened and meets nursing facility level of care. He meets TSOA financial eligibility criteria. Mary is approved to get a PERS unit for Joe and she is also registered to attend a local class that provides dementia education for caregivers. She is also authorized to receive respite care so someone is able to care for Joe while she attends the class.

What are the financial eligibility criteria for TSOA?

The person who receives the care must be:

• Age 55 or older and live in a home setting
• A Washington State resident
• Meet the citizenship and immigration eligibility for federally funded medicaid
• Meet NFLOC
• Provide a valid SSN or proof of application for an SSN
• Meet income requirements under WAC 182-513-1635
• Meet resource requirements under WAC 182-513-1640

A person may be authorized services under the TSOA program while also applying for medicaid. However, if the person is approved for medicaid, TSOA must be closed.

What LTSS financial rules don’t apply to TSOA services?

Certain provisions that apply to traditional long-term care services don’t apply to people who are eligible for TSOA. These include:

• Transfer of asset penalties under WAC 182-513-1363;
• Excess home equity provisions under WAC 182-513-1350;
• Annuity provisions under WAC 182-516-0201;
• Participation requirements under WAC 182-515-1509;
• Disability requirements under WAC 182-512-0050;
• Requirement to do anything necessary to obtain income under WAC 182-512-0700(1)
• Assignment of rights and cooperation under WAC 182-503-0540.

Recovery and TEFRA liens (Chapter 182-527 WAC)

Estate Recovery doesn’t apply to services paid by the TSOA program. Likewise the state can’t establish a TEFRA lien for the cost of services provided under this program.