Worker responsibilities

The interview can be conducted in person or by phone. Call the client or their representative to complete an interview. If they can't be reached, or are unavailable, send an appointment letter (DSHS 0011-01) and a request for verification letter for what is needed to determine eligibility, based only on what was declared on the application.

The PBS must:

Go over the application, particularly what was declared in the income and resource sections. Ask about other resources not declared on the application. General open-ended questions about resources and income should also be asked. Family members and other representatives are often just learning about the client's income and resources when they apply. Open-ended questions often reveal that additional sources of income and assets may exist.

Document in ACES remarks, in detail, all eligibility factors discussed during the interview and included on the application.

If not already authorized, request authorization for AVS for the client and any applicable financially responsible people. Ensure AVS procedures are followed.

Ask about any transfers, gifts, or property sales during the 5-year look back and the circumstances of why they were made. Request verification of transfers, gifts or property sales, if applicable.

Ask about other medical coverage. If there is other medical coverage and you can obtain the information during the interview, complete a 14-194 medical coverage form in Barcode.

Ask if there are unpaid medical expenses and request verification if medical expenses exist. Ask if any of these bills were incurred within the last 3 months.

Explain the financial and social service functional eligibility process. Explain to the applicant that there is a Public Benefits Specialist (PBS) and a social service manager making determinations concurrently for LTSS eligibility.

For in-home service applicants, discuss the food assistance program and inquire if the household would like to apply for food benefits.

Explain the medical service card, automatic Medicare D enrollment if not on a creditable coverage or Medicare D Prescription Drug Plan.

Explain the Medicare Savings Program (MSP). If the applicant is eligible for an MSP based on income and resource guidelines and all information is received to determine eligibility for MSP, don't hold up processing this program while the LTSS medical is pending.

Explain participation and room and board, how the amount is determined, and that it must be paid to the provider.

Explain Estate Recovery and mail the Estate Recovery fact sheet.

Explain what changes of circumstances need to be reported

In the case of the community spouse, explain how all resources in excess of the $2,000 resource limit must be transferred to the spouse within 1 year and the requirement to provide verification of this by the first annual review.

Summarize what verification is needed to complete the application and send a request for information letter. Encourage the applicant to gather documents as soon as possible to expedite the process. Explain how to request an extension if more time is needed.

Summarize the interview and items still needed to determine eligibility in the ACES narrative.