Washington Tailored Supports for Older Adults: Washington 2026 Guide
Tailored Supports for Older Adults (TSOA) is a Washington program under the 1115 Medicaid Transformation demonstration that helps people who are not on Apple Health but meet nursing facility level of care, and their unpaid family caregivers.
This page explains, in plain language, who can get Tailored Supports for Older Adults in 2026, what it pays for, how to apply, what to expect if there is a waiting list, and how it fits with nursing home Medicaid. For the full statewide rules on income, assets, spouses and the look-back, see our Washington Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What Tailored Supports for Older Adults is
TSOA uses higher income and asset limits than Apple Health. Benefits include caregiver supports and, for people without a caregiver, a limited personal care benefit. Since December 1, 2025, Washington has paused new enrollment in MAC and TSOA, with a statewide first-come, first-served waitlist and no set end date.
This is a bridge program for people not yet eligible for, or not yet needing, full long-term care Medicaid. They cover a limited set of services, with different rules on cost sharing.
Who qualifies in 2026
Washington looks at both how much help a person needs and what they own and earn. In general, to qualify for Tailored Supports for Older Adults an applicant must:
- be 55 or older;
- not be on Apple Health;
- meet nursing facility level of care; and
- meet TSOA financial rules.
Finances. See the rules above; they are not the standard long-term care Medicaid limits. Eligibility for one program does not decide eligibility for another.
Financial rules. TSOA uses higher limits than full Medicaid: income up to about 300 percent of the SSI rate ($2,982 a month in 2026) and assets above the regular limit, set by DSHS. There is no estate recovery for TSOA services.
For reference, these are Washington’s key 2026 long-term care Medicaid figures:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (special income level) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $1,130,000 |
| Spouse at home: resource allowance | The greater of $72,529 or half the couple’s assets, up to $162,660 |
| Spouse at home: monthly income allowance | Minimum $2,705 (from July 1, 2026) / maximum $4,066.50 |
| Personal needs allowance (nursing home) | $108.74 a month |
| Look-back period | 60 months (5 years) |
If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.
Services Tailored Supports for Older Adults can cover
Services are listed in a written plan of care, built from the assessment and the person’s goals. Not everyone gets every service. Depending on need, Tailored Supports for Older Adults can include:
- caregiver assistance services, including respite
- training and education
- specialized supplies
- personal care for those without an unpaid caregiver
- personal emergency response systems
Not included. Round-the-clock care and residential costs are outside Tailored Supports for Older Adults.
How to apply for Tailored Supports for Older Adults
The usual sequence for Tailored Supports for Older Adults is below. Running the financial application and the care assessment in parallel can shorten the wait.
- Contact the local Home and Community Services (HCS) office of DSHS Aging and Long-Term Support Administration, or the local Area Agency on Aging, and ask for a long-term care assessment.
- Apply for Washington Apple Health long-term care coverage through DSHS, online or on paper, if not already enrolled.
- A DSHS or Area Agency on Aging case manager completes the CARE assessment, which decides eligibility and the number of hours.
- Choose an individual provider (often a family member) or a home care agency, or a residential setting where that applies.
- Services start under the plan, with reassessments at least yearly.
Tips for the paperwork. Keep a folder of copies, and log every call with the date and name. During the assessment, describe a typical bad day rather than a good day, and have a family member present who knows how much help is really needed. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.
Waiting lists and timing
New TSOA enrollment has been paused since December 1, 2025, with a statewide waitlist.
Starting the process early keeps options open if a wait develops. In the meantime, families often combine state plan personal care, adult day, PACE in areas that have it, and Area Agency on Aging services. The waiver waiting lists page explains common rules.
How it relates to nursing home Medicaid
This program works earlier in the timeline, before nursing home care is needed. When needs increase, full long-term care Medicaid, with its own financial rules and look-back, is the next step.
Planning around Tailored Supports for Older Adults
The need for Tailored Supports for Older Adults often arrives suddenly, after a hospital stay or a fall. Some preparation goes a long way. A good first step is a short written picture of the day: which tasks need help, who does them now, and what the backup is. The same list helps at the assessment and makes it clear where paid help matters most.
For the Medicaid application, collect bank statements, income notices, insurance cards, and proof of identity and Washington residence. Keep older statements too: if a waiver or nursing home becomes necessary, the five-year look-back applies. Legal documents matter too. A durable power of attorney and a health care directive let a trusted person act on applications without a guardianship.
Check in on how the arrangement is working every few months; a reassessment can adjust hours or services. Notes on falls, hospital visits and new diagnoses make later reviews easier.
Tips for families
It can relieve a caregiver before burnout and clarify what help is really needed. Notes on how needs change help with future applications. Plan around the five-year look-back if full Medicaid is likely.
Because Tailored Supports for Older Adults combines a care test, a money test and sometimes a wait, a Certified Medicaid Planner familiar with Washington can be a real help: checking finances against the 2026 limits, flagging look-back issues and keeping the application on track. Costs range widely, from about $150 to $600 an hour, about $500 to $6,000 for application help, and about $2,500 to $15,000 or more for full planning.
Related pages
- Washington Medicaid guide
- Washington Medicaid Alternative Care
- In-home care and Medicaid
- Nursing home alternatives
- HCBS waivers explained
- The five-year look-back
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.