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Community First Choice (CFC)
WA Health Care Authority
Community First Choice (CFC) is a Washington Apple Health state-plan benefit authorized under Section 1915(k) of the Social Security Act, effective 7/1/2015. CFC enables HCA and its contracted entities to deliver person-centered HCBS LTSS to Medicaid-eligible people who meet the institutional level of care under WAC 388-106-0355. Functional eligibility is based on a CARE assessment under chapters 388-106 and 388-828 WAC; authorization is by DSHS Home and Community Services (HCS) or DDA Community Services (DDCS). CFC services include personal care, skills acquisition training, PERS, caregiver management training, and nurse delegation (per WAC 388-106-0270 through 388-106-0295).
Who qualifies
(1) Functionally eligible for CFC services under WAC 388-106-0270 through 388-106-0295 (meets institutional level of care); AND (2) financially eligible under one of: (a) a noninstitutional Apple Health/Medicaid program providing CN or ABP scope of care; (b) through 9/30/2027, a spousal impoverishment protections institutional (SIPI) spouse under WAC 182-513-1220; or (c) an HCB waiver under chapter 182-515 WAC. Excluded if only coverage is through Medically Needy, Premium-based Children's, MSP, Family Planning, MCS, Pregnant Minor, AEM, state-funded LTC for noncitizens, or Kidney Disease programs. Home equity limits (WAC 182-513-1350) do NOT apply unless the client is seeking LTSS available only through an HCB waiver (same rule as transfer-of-asset penalties under WAC 182-513-1215).
What it covers
CFC service package per WAC 388-106-0270 through 388-106-0295: personal care services, skills acquisition training, personal emergency response systems (PERS), caregiver management training, and nurse delegation. May be delivered in own home, adult family home, or assisted living/adult residential care.
Cost
Post-eligibility treatment of income (participation) does NOT apply when CFC eligibility is based on a noninstitutional CN/ABP program or SIPI spousal protections (WAC 182-513-1215(1)(a) or (b)); but DOES apply when eligibility is via an HCB waiver (1)(c). Clients in alternate living facilities (ALFs) keep a Personal Needs Allowance (PNA) and pay up to the room-and-board standard under WAC 182-513-1105. CFC clients on the Health Care for Workers with Disabilities (HWD) program pay the HWD premium plus room and board if in an ALF. Transfer-of-asset penalties (WAC 182-513-1363) and home equity limits (WAC 182-513-1350) do NOT apply unless the client is also seeking LTSS available only through an HCB waiver. Both follow the same exception rule under WAC 182-513-1215. SIPI-spouse resource standard: $2,000 individual; community spouse may receive an allocation of countable resources. Specific PNA, MNIL, and room-and-board dollar amounts are published at hca.wa.gov program-standard-income-and-resources.
How to apply
Apply through your local DSHS Home and Community Services (HCS) office or, for clients with developmental disabilities, through DDA Community Services (DDCS). HCS staff complete the CARE functional assessment and the Apple Health financial determination.
Where to get this in Washington
2 organizations deliver this program. Coverage varies, so check the area each one serves.
Free public agency that helps older adults and people with disabilities in central Washington find in-home care, caregiver support, nutrition, transportation, and benefits help.
Seattle Human Services division that serves as the AAA for King County. Runs Community Living Connections for aging/disability help and administers caregiver support, healthy aging, and age-friendly programs.
Source www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple