Equal Access - Necessary Supplemental Accommodation (NSA) and Long Term Care
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Equal Access - Necessary Supplemental Accommodation (NSA) and Long Term Care

Revised March 3, 2014

Purpose: To explain Aging and Long term supports administration (ALTSA) policies related to NSA and long-term care. Necessary Supplemental Accommodation (NSA ) is also known as equal access (EA)

NSA-Equal Access and clients receiving ALTSA/HCS LTC services

ACES manual equal access

EAZ manual NSA-Equal Access for cash and food

Medical-Health Care Authority Equal Access

Additional information is followed by Aging and long-term support administration (ALTSA) for individuals receiving  ALTSA services.

The following information is from chapter 3 of the long-term care manual used by ALTSA/HCS social services. This describes the responsibilities of the HCS SW or AAA case manager.   All ALTSA LTC clients are treated as if they are NSA.

Clients who have a mental, neurological, physical, or sensory impairment or other problems that prevent them from getting program benefits in the same way as those who are not impaired are considered in need of necessary supplemental accommodation/Equal Access.  (WAC 182-503-0120)

Developmental Disabilities Administration (DDA) follows Policy 5.02 Necessary Supplemental Accommodation in the DDA policy manual.   

ALTSA/HCS Social Worker and AAA Case manager responsibilities

Discuss with clients any issues that would hinder their ability to access DSHS programs and services and determine if they require any necessary supplemental accommodation/equal access services to ensure that they can submit the necessary information to the financial worker for an initial (or on-going) determination of eligibility for Medicaid.  If the client requires or requests NSA/EA:

  1. Select “Yes” on the Care Plan screen that the client has a need for a “NSA”.
  2. Identify any special needs he/she may have which would impact his/her ability to complete the initial application for public assistance and any reviews for ongoing eligibility;
  3. Describe the plan in the comment box labeled “NSA description”;
  4. Identify the family member, significant other, or other individual who can be identified as the person the financial worker can contact (requires Consent – DSHS Form 14-012);
  5. Assist clients who are unable to manage this issue independently if no NSA is identified. 

EXAMPLE:  The client has significant cognitive impairment and cannot be responsible for the application and eligibility review process.  Her daughter, who is her DPOA, will be identified as the contact person for the financial application process.

EXAMPLE:  The client cannot read. All form must be sent to the designated representative.

EXAMPLE:  The client has a hearing impairment so staff should not contact the client by phone or would need to use the TTY system when appropriate.

Implementing the Necessary Supplemental Accommodation (NSA) - Equal Access

In addition to documenting NSA/EA information on the Care Plan screen, you must:

  1. Describe the needed special accommodations to the ALTSA financial worker on form 14-443. Include the address of the person identified as the client’s representative.
  2. Document in the SER or include a copy of the form in the case file.
  3. If the client does not have anyone to assist them, indicate that HCS/AAA social workers or case managers will need to arrange for, or provide assistance with, completing forms, obtaining needed information, explaining the department’s adverse actions, requesting fair hearings, and providing follow-up contact on missed appointments. Social workers and case managers may be notified by financial workers that the client needs further assistance with their Medicaid eligibility reviews to ensure that there is no interruption in Medicaid eligibility.

HCS/AAA case records must be identified (or flagged) if the client has specific needs identified (e.g. large size print for forms, hearing impairment, cognitive impairments, limited reading ability, etc.) that are in addition to the required accommodations that are already identified in HCS policy.  “NSA” is printed on the outside of the case record folder.  Although all ALTSA/DDA LTC clients are treated as if they are NSA, only develop an NSA plan and mark the case “NSA” if the client has specific NSA needs

ALTSA/HCS Financial Worker Responsibilities


  • Currently ALTSA clients are presumed to be designated NSA (Necessary Supplemental Accommodation now known as Equal Access (EA)).  EA accommodation plans are documented in ALTSA case files (CARE).  NSA screens do not need to be completed in the ACES system as long as the plan is documented in CARE. 
  • If requested information needed to complete an application is not received, refer to the assigned social worker or case manager using the 65-10 for assistance in getting the needed information into the office.  Check for a response after 10 days and make sure to contact the social worker regarding the status prior to denying the application.
  • If an eligibility review or request for information to establish eligibility is overdue and information has been sent to the client with no response, refer to the client case manager using the 65-10 for assistance in getting the needed information into the office.  Do not terminate a LTC with an overdue review prior to NSA steps taken. 
  • Complete a 65-10 referral to the client social worker or case manager requesting assistance in providing necessary information.  Clearly indicate on the referral what is needed for continued eligibility and what is needed to assist the client in providing that information. 
  • Make sure all attempts to assist the ALTSA client is documented including phone calls to the client, referrals or discussions with the social worker or case manager. 
  • See AREP screens for Long-term care cases  for instructions on when an AREP screen is completed.  

Processing Late Eligibility Reviews

It is the policy of ALSTA to ensure all clients receiving LTC services are given the required NSA/EA to services.  See LTC renewals  for complete instructions on processing late reviews.

Modification Date: March 3, 2014