Guide to CARE Tool Assessments

If you want the state to pay for personal care you get in your home, you must meet financial and functional requirements. The Department of Social and Health Services (DSHS) must follow state rules in deciding if you meet these requirements when you apply for Medicaid. 

You meet financial requirements if your income and resources (assets) are under certain levels.

Meeting functional requirements means you need certain types of help with daily tasks such as eating, using the toilet, bathing, dressing, moving, or taking medication. 

DSHS has different programs providing personal care services. The functional requirements for each are a little different. You can find each program’s functional requirements in these state rules:

•  Medicaid Personal Care (mostly for people who get SSI)
• Community First Choice
• Developmental Disabilities Administration
• COPES
• Nursing facilities

DSHS decides if you meet functional requirements after having a case manager meet with you to do a personal care assessment, also called a CARE tool assessment or a CARE assessment. The case manager will ask you about help you’ve gotten to take care of yourself. DSHS or your Area Agency on Aging uses your answers to decide what services you can get, such as personal care hours and nursing services. 

It’s important to understand how your answers will affect how much care and what kinds of care you can get so that you can prepare for your assessment. DSHS has a key to the terms used in the assessment available in multiple languages. 

After your assessment, DSHS will send you a letter that should explain the services DSHS believes you need. It should have information about how much help you need with each task, and if you already get any free help. 

DSHS may decide that you don’t meet the functional and financial requirements, or may not give you enough care hours. If you disagree with DSHS’ decision, you can do any or all of these: 

• Ask for a hearing. You can ask for a hearing by phone. It’s best to make a written, dated request for a hearing and keep a copy. You’ll get a hearing request form with your Planned Action Notice.
  Even if it looks like you can work things out with DSHS, ask for a hearing just in case you need one. It’s easy to cancel (to withdraw) a hearing request if things work out.
• Ask for corrections or additions. If any information in the assessment is wrong or missing something, send DSHS a dated letter explaining your concerns in detail. Ask them to respond in writing. Keep a copy of your letter.
• Ask for a reassessment. If your need for help has changed a lot since your last assessment, ask DSHS to reassess you.