The Community First Choice Option (CFCO) from Washington State Medicaid (Apple Health)

 What are Community First Choice Programs?  Until recently Medicaid provided services to the elderly three ways: in nursing homes, at home through "HCBS Waivers" and through regular Medicaid under the "personal care" option.  Each has its shortcomings. The Affordable Care Act allows states to create a fourth option to provide aging care that addresses some of the previous limitations.

Program Description

The Community First Choice Option (CFCO) is an innovative Washington state Medicaid program that provides "attendant care" and non-care related assistance services to aging residents who'd otherwise require nursing home placement.  Assistance may be provided in any of these three settings: the participant's home, an assisted living facility, or an adult family home. 

 The CFCO allows family members to receive payment for providing personal care to their loved ones.

The personal or "attendant care" provided under the CFCO can be self-directed by the program participant.  This means they have the option of choosing from whom they receive care services.  They are permitted to "hire" family members as care providers.  Family members will receive the Medicaid approved rate for non-medical care providers in Washington, which is estimated at $12-$14 per hour.

The rollout of the CFCO means there is some redundancy with other Washington State long term care programs.  Most impacted are the COPES Waiver and Medicaid Personal Care (MPC).  For personal care and related services, CFCO has largely replaced these programs.  However, CFC requires a need for institutional level of care while MPC does not, the MPC program still exists for clients who do not meet the higher qualification level.  There are also others services that are not offered under CFCO.  Individuals can receive assistance from both programs concurrently, but not for the same service. 

Washington's Department of Social and Health Services has made the Community First Choice Option available through Washington State Medicaid (also known as Washington Apple Health or WAH) since 2015. 


Eligibility Guidelines

Interested residents can participate in the CFCO if they can demonstrate the level of care and the required financial resources.

Level of Care Required
Individuals over 65 must demonstrate a need for either a nursing facility level of care or an intermediate care facility level of care. This means that they may require help with items like showering, getting dressed, going to the bathroom. Need is demonstrated with an assessment by the state's Department of Social and Health Services.

Income and Assets in 2017

For those 65 and above (or those who are blind or disabled) individual applicants must have gross monthly incomes under $2,205. This amount is referred to as a ‘Special Income Level’ and is three times the Federal Benefit Rate. This figure is updated annually per the cost of living adjustment. 

Some very low income seniors can qualify without asset limits if their total income is below $735. Most applicants must meet limits on total wealth. These rules exclude the value of one's home, so long as the applicant or their spouse are living in it.

Individuals should not have more than $2,000. This figure does not change annually. The cap on the assets also depends on the applicant's marital status. To prevent a non-applying spouse from going broke, the state permits married couples to retain at least $54,726 and up to $122,900 in 2017.

In these eligibility guidelines, we have attempted to simplify the financial eligibility for CFCO and for Washington Medicaid (Apple Health). However, the process and procedures are complicated.  There are many rules, exceptions, and strategies to ensure one's eligibility. It is recommended that persons unsure of their eligibility status get guidance from a professional familiar with the Apple Health eligibility rules prior to applying. Read more about this option.


Benefits and Services

CFCO primarily benefits participants their personal care needs.  Participants choose between receiving residential-based personal care (such as in assisted living), self-directed in-home care, or services from a home care agency. Participants retain their choice of care provider regardless of the care setting.

Personal care, also referred to as attendant care, is defined as assistance with activities such as: eating, dressing, toileting and bathing.  Other types of assistance include:

  • Medication assistance
  • Nursing tasks such as insulin injections or blood glucose monitoring
  • Housework
  • Transportation assistance
  • Respite care
  • Assistive technology
  • Personal emergency response services (up to $500 annually)
  • Community transition services (up to $850 in financial assistance to facilitate a move from residential care to a personal home)

Unlike some Medicaid programs, Community First Choice is not an all-or-nothing option. Participants can receive assistance under CFCO and from a Medicaid Waiver, such as COPES, concurrently provided the assistance is not for redundant services. This is especially relevant for adult day care, which is offered by the COPES waiver, but not through CFCO.

How to Apply / Learn More

Seniors wishing to apply for the Community First Choice Option should file an online application. For assistance with the application or to request a paper application, you should look up the local aging services organization for your county.  

Staff from the area agency on aging in Washington recommend the use of the web application because it is generally processed faster. Regardless of whether you decide to file electronically or with a traditional application, it is still necessary to have all of the required documentation to support the application.