1. Home and Community Services Social Services Programs

2. Agenda: Mission and vision Eligibility determination CARE assessment
Long-term care programs
Long-term care settings
SNF, hospital, behavioral support units
MAC & TSOA
Other supports

3. Aging and Long Term Support Administration
Vision
Seniors and people with disabilities living with good health, independence, dignity, and control over decisions that affect their lives.
We want to share the Vision of ALTSA with you so you can see how HCS services fit into the bigger picture.

4. ALTSA Mission
To transform lives by promoting choice, independence and safety through innovative services.
HCS is one Division within ALTSA, and we all share the same Mission.

5. Home and Community Services
HCS determines initial & ongoing eligibility for long-term care services (LTC) and authorizes services to contracted providers.
Once we receive an application for Medicaid LTC,
we determine:
Financial Eligibility ~ completed by a financial worker
Functional Eligibility ~ completed by a SW or RN
Both processes may occur at the same time.
Being the front door for the state’s community-based long-term care services a large part of what we do is handle requests for assistance from people in the community. What this typically means is HCS…

6. How is Functional Eligibility Determined?
CARE assessment = Comprehensive Assessment & Reporting Evaluation
The CARE assessment is used to take a comprehensive evaluation of an individual’s functional abilities by reviewing their medical and psych/social conditions.
The need for assistance with personal care tasks or “activities of daily living” (ADL’s) are the primary consideration of functional eligibility.
Social Services manages the Functional eligibility piece. Cases are assigned to SWs or RNs once a Medicaid application is submitted to HCS.

7. CARE Assessment Activities of Daily Living (ADL’s):
Medication management
Bathing
Dressing
Bed mobility/positioning
Transferring
Ambulation
Eating
Toileting
Personal hygiene/skin care
The initial CARE assessment can take up to 3 hours, as it is very comprehensive.
Activities of Daily Living – personal care tasks.

8. CARE Assessment
Some sections of the assessment are evaluated based on client performance during “look back” periods of time, as opposed to looking toward the future.
The need for or receipt of assistance with housework, shopping, meal preparation, and transportation do not impact eligibility in and of themselves.
Explain “Look Back” periods.

9. CARE Assessment
The assessment is completed on an initial and annual basis as well as when client’s care needs change significantly.
Circumstances for possible deduction of in-home care hours:
Willing, informal supports that are available to client
Caregiver who lives with client
Multi-client household
Once the CARE assessment is completed, the number of hours per month for in home OR daily rate for residential settings is determined.
The CARE assessment is used to:
provide documentation of the individual’s care needs,
assist in locating placements,
provide a care plan for the client and caregiver

10. Long Term Care Programs
Once a person is financially and functionally eligible, we discuss the program options:
CFC - Community First Choice
COPES – Community Options Program Entry System
MPC – Medicaid Personal Care
New Freedom
PACE – Program of All-Inclusive Care for the Elderly
RCL - Roads to Community Living
Community First Choice – CFC, is the new State Plan benefit due to changes and requirements of the Affordable Care Act. Personal Care was refinanced under the new State Plan benefit – CFC – vs being part of the COPES waiver.
The changes allow for a richer benefit package to better support individuals in the community
The federal match increased from 50% under COPES to 56% in CFC.
Most LTC Medicaid clients in WA state will be using the State Plan benefit of CFC vs MPC.

11. Here is a brief look at the various programs offered through HCS.

12. Long Term Care Settings
In-home personal care (homecare agency or individual provider)
Residential placement and case management in licensed facilities with a Medicaid contract:
Adult Family Home (AFH)
Assisted Living Facility (ALF)
Adult Residential Care (ARC)
Enhanced Adult Residential Care (EARC)
Skilled Nursing Facility case management and relocation care planning
Client’s choices and wishes are highly valued and respected. The CARE assessment encourages Person Centered Planning.
Safety of client is a primary consideration
HCS provides case management for clients who live in residential settings (AFH/ALF/SNF/ARC/EARC) The SW/RN will review all the setting options for LTC services.

13. Individual Provider (IP)
In-Home Personal Care
Homecare Agency
Many contracted agencies to choose from
Agencies provide supervision and support to caregiver(s)
Back-up caregivers available
Individual Provider (IP)
Family (other than spouse) or person of choice
IP’s are contracted directly through DSHS
They become a member of a union (SEIU)
Must pass background check, fingerprinting and complete initial and ongoing training requirements
*DSHS only does initial assessment. Case management & follow-up assessments are done by one of our area agencies on aging (AAA’s)
24 hour care cannot be provided in home.
Case management for clients who choose in–home care is provided by the Area Agency on Aging (AAA)
IP Training includes:
View & report back on 5 hour initial training DVD’s
Complete 70 hours of training within 120 days of hire (with some exceptions)
Pass test to become a certified homecare aide through Department of Health within 200 days of hire ($115)

14. Residential Care Adult Family Home (AFH) Adult Residential Care (ARC)
Must have certification for mental health, dementia, &/or developmental disabilities if resident(s) have such a diagnosis
Licensed and contracted for up to 6 residents
Adult Residential Care (ARC)
Typically low-level physical care needs
Assisted Living Facility (ALF)
Single rooms
Provides nursing care
Enhanced Adult Residential Care (EARC)
Provides limited nursing services
*Residential is the only community setting for 24 hour care
*Case management & follow-up assessments are done by DSHS
Adult Family Home (AFH) – All programs accepted except New Freedom
Assisted Living Facility (ALF) - All programs except MPC & New Freedom
Enhanced Adult Residential Care (EARC) – All programs except MPC & New Freedom
Adult Residential Care (ARC) – all programs are now available in an ARC

15. Skilled Nursing Facilities (SNF)
Options include long-term, rehabilitation, and temporary placements
HCS determines Nursing Facility Level of Care within 10 days of admission
CARE assessments are completed to assist clients in relocation to more independent settings
Relocation efforts include help with identifying the next setting, determining equipment and other support service needs

16. Hospital Unit
Conducts functional assessments for clients who are inpatient at all King County hospitals and SNF’s within hospitals.
Assist hospital Social Workers/discharge planners with establishing safe discharge plans for clients.
Assist with funding for non-covered DME items.
Determine and implement supportive services.

17. Behavioral Support Unit
Assists HCS LTC clients residing at Western State Hospital, Department of Corrections and local psychiatric hospitals to transition back to a community setting.
Case manage clients in Region 2 who have been identified as having exceptional care needs due to behavioral issues.
Provide case staffing for difficult and challenging cases.
The Behavioral Support Unit provides case management to designated clients and manages Expanded Community Services to eligible clients.

18. Cost to Clients
Clients may have to contribute to the cost of their care depending on their medical program coverage, monthly income, and/or marital status.
This is called “client responsibility” or “participation”.
Financial determines “participation” or “Client Responsibility” in most cases.

19. Medicaid Alternative Care (MAC)
Supports for unpaid caregivers caring for individuals on Medicaid (CN/ABP) but not receiving LTC/caregiver services
Caregiver assistance services (including respite if caregiver is providing 40 hrs/wk of unpaid care)
Training, education & consultation
Specialized equipment & supplies
Health maintenance & therapies
No participation/client responsibility
No estate recovery
Care receiver must be 55+ & NFLOC
Eligibility provides:
Max of $558/month, $3345/6 months depending on circumstances (determined by AAA)
HMA = up to 6 months of housing costs = $ per month while in a SNF if approved
Other supports are COPES Ancillary Services that are available when a client is eligible

20. Tailored Services for Older Adults (TSOA)
Pre-Medicaid services & supports for individuals with or without an unpaid caregiver
Caregiver assistance services (including respite if caregiver is providing 40 hrs/wk of unpaid care)
Training, education & consultation
Specialized equipment & supplies
Health maintenance & therapies
Personal care services (if there is no unpaid caregiver)
No participation/client responsibility
No estate recovery
Care receiver must be 55+ & NFLOC
Income must be $2250/month or less; resources must be less than $53,100 (individual) or $108,647 (married couple)
Eligibility provides:
Max of $558/month depending on circumstances (determined by AAA)
HMA = up to 6 months of housing costs = $ per month while in a SNF if approved
Other supports are COPES Ancillary Services that are available when a client is eligible

21. Other Supports Home Maintenance Allowance (when in SNF < 6 mos.)
Client Training (COPES)
Chronic Disease Self Management
Nutrition Services
P/T, O/T & S/T
Independent Living Skills
PEARLS (at-home counseling)
Home Delivered Meals (COPES)
PERS - Personal Emergency Response (CFC)
HMA = up to 6 months of housing costs = $ per month while in a SNF if approved
Other supports are COPES Ancillary Services that are available when a client is eligible

22. Other Supports (COPES)
Specialized Medical Equipment
Environmental Modifications
Adult Day Health
Adult Day Care
Skilled Nursing
Wellness Education
The client’s assessment results will influence the Care Plan.
When a Care Plan indicates the need for additional supports, the SW/RN will discuss and authorize the necessary services.

23. Web Resources
Medicaid Application:
DSHS Social & Health Services for Adults:
Forms in the Publication Library:
Medicaid and Long-Term Care Services for Adults
Choosing Care in an Adult Family Home or Boarding Home
Partners in Protection: A Guide for Reporting Vulnerable Adult Abuse
Summary of Home and Community Services and Eligibility

24. Home and Community Services
Region 2 South
1737 Airport Way South
Seattle, WA