See Ongoing Additional Requirements in the Eligibility A-Z Manual for more information about role of the Financial Worker in setting up OAR benefits for the customer.
1. A customer may request Ongoing Additional Requirements from either financial eligibility staff or Social Service Specialist. If the request is made to financial eligibility staff, they will direct customers to a Social Service Specialist.
2. The Social Service Specialist verifies the need and determines eligibility for OAR benefits through an assessment. The assessment may include an interview, collateral contacts, or verification from a provider. If verification is needed to make an OAR decision, refer to the CSD Procedure Handbook for next steps. The Social Service Specialist determines if the need is one-time or reoccurring. Some benefits are only a one-time payment. Other benefits can occur monthly and are reviewed at regular intervals (see Review Periods in WAC 388-473-0010). An example of a one-time benefit is an individual who needs assistance obtaining a bus pass at a reduced rate. Once the bus pass is obtained, they are able to pay the reduced rate ongoing and would not need continued OAR for transportation.
3. We do not approve Ongoing Additional Requirement benefits if:
a. The assistance they are requesting is available to them through another program (TANF, RCA, HEN, etc.); agency (ALTSA, DDA, etc.); provider; Medicaid; or community partners.
b. The person lives in an institution, licensed Adult Family Home (AFH), Assisted Living Facility (ALF), or Enhanced Services Facility (ESF);
c. The assistance unit is a child-only case; or
d. The request is for a child in the household. Children are not eligible for OAR benefits.
4. We approve OAR when we have all information and verification needed to make a decision.
5. For HCS cases, the HCS social worker or Area Agency on Aging (AAA) case manager makes the determination of the need of OAR and notifies the financial worker of the decision using the DSHS 14-443 Financial Social Service Communication form. (This form is located in the Barcode ECR under the forms tab.)
All initial requests begin with an assessment by the Social Service Specialist. Certain benefit types have conditions for approval and verification or documentation that is needed before a decision regarding OAR can be made. Refer to chart below. For medically related benefits, see section below under Worker Responsibilities-WAC 388-473-0080.
Benefit Type |
Conditions for Approval |
Verification/ Documentation Requirements |
---|---|---|
Transportation |
Customer needs assistance getting to and from appointments; or taking care of activities to continue living independently. |
Not applicable |
Internet service |
Customer needs assistance paying the monthly bill. Customer needs internet access to continue living independently. |
Verification customer has applied for low-cost internet with their provider and the internet bill amount.
|
Veterinary costs for service animal |
The service animal, per RCW 49.60.040 Section 25, is in need of veterinary care to continue to provide service to the individual and the individual needs the service animal to continue to live independently |
Verbal or written cost estimate for veterinary appointment or note from the veterinary clinic about services needed on veterinary clinic letterhead. If the cost is more than the OAR benefit, discuss with the customer how they will meet the remaining need.
Service cannot already have occurred. |
Boarding for Service Animals |
The customer has a service animal and needs it to continue to live independently. The customer is going into inpatient care and is willing to board their animal in a licensed facility, not with family or friends. |
Verbal or written information from a provider showing the customer is in need of inpatient care for any reason (e.g. physical, mental, substance use) and a cost estimate from a licensed boarding facility.
Note: Most licensed boarding facilities require up to date vaccinations for the animal. |
Restaurant Meals |
Customer is unable to safely prepare meals and home-delivered meals are not available or would be more expensive. |
Documentation from their provider or medical evidence that indicates an inability or safety concern to prepare own meals. |
Home-delivered Meals |
Customer is unable to prepare any of their meals, are physically limited in ability to leave their home, and home-delivered meals are available. |
Documentation from their provider or medical evidence that indicates an inability or safety concern to prepare own meals.
Verify the amount being charged by the local home delivery agency. |
Laundry |
Customer is not able to physically do their own laundry or does not have access to laundry facilities that are accessible, based on physical limitations. |
Documentation from their provider or medical evidence that indicates they are physically unable to do their laundry or there are not laundry facilities that are accessible, based on physical limitations. |
Service Animal Food |
The service animal is necessary for customer’s health and safety and supports their ability to continue to live independently. |
Customer’s self-report and if questionable, a statement from their medical or mental health provider that the service animal is needed. |
Telephone (landline) |
The customer has applied for the federal program and needs assistance with paying for a landline. |
Customer’s self-report. |
1. Review eligibility cycles for Ongoing Additional Requirements using the chart below also found in WAC 388-473-0010.
Program | Frequency |
TANF/RCA/SFA/PWA | 6 months |
ABD | 12 months |
HEN referral | 12 months |
SSI | 24 months |
All | Any time need or circumstances are expected to change |
a. However, if the Social Service Specialist determines that the person does not need the OAR service for the entire review period, it can be approved with a shorter review period.
b. Reviews can be done early “any time need or circumstances are expected to change” per WAC 388-473-0010.
The ADA (Americans with Disabilities Act) defines a service animal as any guide dog, signal dog, or miniature horse trained to provide assistance to an individual with a disability. If they meet this definition, animals are considered service animals under the ADA, regardless of whether they have been licensed or certified by a state or local government. Any reference below to service animal follows this definition.
Service animals perform some of the functions and tasks that individuals with a disability cannot perform for themselves. Guide dogs are one type of service animal, used by some individuals who are blind. This is the type of service animal with which most people are familiar, but there are service animals that assist persons with other kinds of disabilities in their day-to-day activities.
Some examples include:
A service animal is not a pet or an emotional support animal, per ADA guidelines.
1. Use the following criteria to determine if the person's OAR request for a service animal qualifies for benefits. The dog or miniature horse:
a. Must help the person with a sensory, mental, or physical disability.
b. The training does not need to be formal, but the dog or miniature horse should be trained to help the person with tasks related to the disability (do not ask for proof of training).
Examples of questions to ask that may be helpful in making a determination:
We issue benefits for medically related items or services when a person did not qualify for the service or item from any state, federal, or private insurance coverage or they have been unable to obtain a replacement through state, federal, or private insurance. Definition of and verification needed for medically related items and services are listed below:
OAR Benefit |
Definition |
Questions |
Request |
---|---|---|---|
Denture replacement |
Customer needs dentures to continue to live independently and has received a denial of denture replacement from Medicaid or private insurance, or upon social service assessment, it is determined that approval for replacement through insurance isn’t likely or feasible. |
Have you been denied a replacement by private insurance or Medicaid? If no, direct them to insurance first.
If so, why?
If not, what other services or resources have you tried to access for assistance?
Does your insurance cover any amount of a replacement set of dentures? If yes, how much? What is your remaining balance due?
If this is a replacement, what happened to the original set (breakage, lost, etc.)? |
A cost estimate from their provider or letter showing the need for replacement.
A denial letter from Medicaid or private insurance (if questionable)
|
Optometrist visit for eyeglasses |
Customer’s eye exam to get prescription glasses (original or replacement) is not covered by insurance and they need eyeglasses to continue to live independently. |
Have you been denied this service through Medicaid or your insurance or have you been told that it is not covered? If no, direct them to insurance first.
Does your insurance cover any amount of an Optometrist visit? If yes, how much? What is your remaining balance due?
How often will your insurance pay for an Optometrist visit (annually, biannually, etc.)?
Have you used up your visits for an eye exam for this year?
Will your insurance approve the benefit if it is medically necessary even if you have already used up your Optometrist visit for the approval period? |
Documentation that the exam is needed (appointment card, note from doctor/optometrist) in order to obtain eyeglasses.
Voicemail/phone call from provider
Documentation stating insurance will not cover cost (if questionable)
|
Replacement of eyeglasses |
Customer has been unable to get replacement glasses through insurance because they were unable to provide proof they were not negligent in misplacing the first pair. The customer reports they need their eyeglasses to cook, read their medication labels, etc. |
Why do you need to replace your current eyeglasses? If broken, are they repairable?
Have you tried to get replacement glasses through your insurance and been denied?
If no, direct them to request from insurance first.
Does your insurance cover any amount of a new set of glasses? If yes, how much does your insurance allow per year? |
Documentation that the replacement glasses are needed (appointment card, note from doctor/optometrist)
Voicemail/phone call from provider
Documentation that insurance will not cover cost (if questionable)
|
Hearing Aid replacement |
Customer has been unable to get replacement hearing aid through insurance and needs the hearing aid to continue to live independently. |
What is the reason for needing to replace your hearing aid?
Are the hearing aids still under warranty?
Have you tried to get a replacement hearing aid through your insurance or Medicaid and been denied?
If so, why were you denied?
If no, direct them to try insurance first.
Will your insurance cover any portion of the replacement cost? |
Documentation that the replacement hearing aids are needed (appointment card, note from doctor/audiologist)
Voicemail/phone call from provider
Documentation that insurance will not cover cost (if questionable)
|
1. Services with an annual limit are limited to one payment every 12 months.
2. The following services are issued at a set standard amount as described in WAC even if the need is less: restaurant meals, laundry, service animal food, telephone, transportation, veterinary cost for service animal. For other services, determine amount based on need not exceeding maximum standard amount.
3. The standards and limits outlined in the WAC are per person, not per household
4. A household could have more than one person who is eligible for the same OAR benefit.
5. OAR amounts for a service animal are limited per person and not per animal.
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