Community First Choice (CFC)
WA Health Care Authority
Community First Choice (CFC) is a Washington Apple Health (Medicaid) benefit that started July 1, 2015. It is run by the Health Care Authority and the agencies it works with. It pays for long-term care and support at home or in the community for people on Medicaid who need nursing-home level care. Whether you qualify is based on a CARE assessment, an in-person review of what help you need with daily activities. Your services are approved by a DSHS Home and Community Services (HCS) office, or by DDA Community Services if you have a developmental disability. Services include personal care, training to build daily-living skills, a personal emergency response system, training for the person who manages your care, and nurse delegation.
Who qualifies
What it covers
Cost
How to apply
How to apply
Call Community Living Connections to ask for an assessment
One call starts both tracks: the functional assessment and the referral to your local Home and Community Services office.
- Community Living Connections 1-855-567-0252
- Washington Connection Open
- Form HCA 18-005, for aged, blind, or disabled applicants Open
- Local DSHS Home and Community Services office or Area Agency on Aging
Documents to gather
- Photo ID
- Proof of income (Social Security, pensions, wages)
- Bank and asset statements
- Medicare card and any other insurance
- Information about daily-living limitations and diagnoses
- Social Security number, citizenship or immigration status, Washington residency
Apple Health applications are decided within 45 calendar days, or 60 days if a disability decision is required. Applications through Healthplanfinder may be decided immediately.
Worth knowing
Community First Choice is an entitlement, not a waiver. There is no waitlist, which is the main practical difference from COPES.
Standalone Community First Choice has no 60 month asset-transfer lookback. The penalty only applies to people who attain institutional status, and Community First Choice is not one of the pathways that confers it. If you access it through a COPES pairing, though, the waiver does confer institutional status and the lookback then applies.
Coverage whose only basis is medically needy, family planning, pregnancy, or a state-funded program does not qualify you for Community First Choice.
Community First Choice is the base personal care benefit. Waiver-only services such as home-delivered meals and home modifications require pairing it with COPES.
Community First Choice has no income limit of its own. It borrows the limit of whichever Apple Health program you qualify under. For someone 65 or older, or on Medicare, that is $994 a month for one person and $1,491 for an eligible couple, with resources of $2,000 and $3,000.
If you reach Community First Choice through a COPES waiver instead, the limit is the long-term care figure of $2,982 a month rather than $994. Standalone and waiver-paired Community First Choice differ on the income standard and on the asset-transfer lookback, and they differ together.
See your next step, the documents you will need, and how to apply. Save it to your account to track your progress.
Where to go from here
Adult Day Center
Adult day centers are daytime programs for adults who need some level of supervision and care but not skilled nursing or rehabilitative therapy. Services typically include personal care, social activities, education, routine health monitoring, therapeutic activities, meals and snacks, transportation coordination, first aid, and emergency care.
Adult Day Health
Adult day health is a daytime program for adults who need skilled nursing care or licensed rehabilitative therapy. Centers provide skilled nursing services, physical/occupational/speech-language therapy, brief psychological or counseling services, plus the personal care, meals, social activities, and health monitoring offered at adult day centers.
Apple Health Classic Medicaid (SSI-related / Aged, Blind, Disabled)
"Apple Health" is Washington's name for all of its state medical assistance programs, including Medicaid. "Classic Medicaid" is the part of Apple Health for people who are 65 or older, blind, disabled, or who need long-term care. These programs count your income the same way Supplemental Security Income (SSI) does, rather than using the tax-based rules that apply to younger adults and families. The state Health Care Authority runs most Apple Health programs. The Department of Social and Health Services (DSHS) runs SSI-related coverage, the state-funded Medical Care Services program, and the Medicare Savings Programs that help pay Medicare costs. If you have both Medicare and Apple Health, Apple Health acts as your second layer of coverage and picks up costs Medicare does not, such as deductibles, copays, hearing aids, and dental. It can also pay for long-term care.
Apple Health for Workers with Disabilities (HWD)
Apple Health for Workers with Disabilities lets working adults age 16 or older who are blind or disabled buy into Medicaid. It provides full Apple Health coverage. Unlike most disability-based Medicaid, it has no asset test and no upper income limit. You qualify based on your disability (using the federal disability rules) and being employed, full or part time, including self-employment. You pay a monthly premium that goes up with income but never goes above 7.5% of your total income. American Indians and Alaska Natives pay no premium. While you are enrolled, you can put earnings into a separate designated account that will not count toward your eligibility for other Medicaid programs.
Not sure this one fits your situation? Your local Area Agency on Aging can check what you qualify for and point you to the right programs, for free. No one will sell your information, and no one will cold-call you.
Source www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple
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