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 four settings: the participant's home, an assisted living facility, adult residential care, or an adult family home. 

 The CFCO allows family members and friends 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 $12.50-$14.50 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 (DSHS) has made the Community First Choice Option available through Washington State Medicaid (also known as Washington Apple Health or WAH) since 2015. CFCO is an entitlement program, which means there are no waitlists and anyone who is eligible for this program is able to receive services.

 

Eligibility Guidelines

Interested residents can participate in the CFCO if they can demonstrate the required level of care need and the have limited 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 activities like showering, getting dressed, and using the bathroom. Need is demonstrated with an assessment by the state's Department of Social and Health Services.

Income and Assets in 2018
For those 65 and above (or those who are blind or disabled) individual applicants must have gross monthly income under $2,250. This amount is referred to as a ‘Special Income Level’ and is three times the current 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 $750. 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, and the equity value of the home is not over $572,000.

Individuals should not have more than $2,000 in total assets. 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 (often called a community spouse) from going broke, the state permits the community spouse to retain at least $55,547 and up to $123,600 in 2018.

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 by assisting with 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 of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as eating, dressing, toileting, bathing, grocery shopping, and meal preparation. Other types of assistance include:

  • Medication assistance
  • Nursing tasks such as insulin injections or blood glucose monitoring
  • Housework
  • Transportation assistance
  • Respite care
  • Skills acquisition training / Assistive technology (up to $550 annually)
  • Training for the consumer direction option (how to choose and manage caregivers, etc.)
  • Personal emergency response services 
  • 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

Additional information about the Community First Choice Option can be found on the Washington State Department of Social and Health Services’ website. Seniors wishing to apply for CFCO 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 one decides to file electronically or with a traditional application, it is still necessary to have all of the required documentation to support the application.