Community First Choice
To explain the Community First Choice (CFC) program that provides long-term services and supports (LTSS). CFC is for people living outside of a medical institution, who are eligible for categorically needy (CN) or alternate benefit plan (ABP) scope of care through Medicaid, and who meet nursing facility level of care (NFLOC) or the criteria to reside in an Intermediate Care Facility for the Intellectually Disabled (ICF/ID). CFC starts 7/1/2015
Functional eligibility is based on a CARE assessment under Chapter 388-106 WAC and 388-828 WAC and can be authorized by Home and Community Services (HCS) or Developmental Disabilities Administration (DDA).
-
WAC 182-513-1210 Community First Choice (CFC) – Overview
-
WAC 182-513-1210 Community First Choice (CFC) – Overview
Emergency effective February 20, 2017
- ​Community first choice (CFC) is a Washington apple health state plan benefit authorized under Section 1915(k) of the Social Security Act.
- CFC enables the agency and its contracted entities to deliver person-centered home and community based long-term services and supports (LTSS) to medicaid-eligible people who meet the institutional level of care under WAC 388-106-0355. See:
- WAC 388-106-0270 through 388-106-0295 for services included within the CFC benefit package.
- WAC 182-513-1215 for financial eligibility for CFC services.
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
-
WAC 182-513-1215 Community First Choice (CFC) – Eligibility
-
WAC 182-513-1215 Community First Choice (CFC) – Eligibility
Effective February 25, 2023
- A client who is determined functionally eligible for community first choice (CFC) services under WAC 388-106-0270 through 388-106-0295 is financially eligible to receive CFC services if the client is:
- Eligible for a noninstitutional Washington apple health (medicaid) program which provides categorically needy (CN) or alternative benefits plan (ABP) scope of care;
- Through September 30, 2027, a spousal impoverishment protections institutional (SIPI) spouse under WAC 182-513-1220; or
- Determined eligible for a home and community based (HCB) waiver program under chapter 182-515 WAC.
- A client whose only coverage is through one of the following programs is not eligible for CFC:
- Medically needy program under WAC 182-519-0100;
- Premium-based children's program under WAC 182-505-0215;
- Medicare savings programs under WAC 182-517-0300;
- Family planning program under WAC 182-505-0115;
- Family planning only under chapter 182-532 WAC
- Medical care services program under WAC 182-508-0005;
- Pregnant minor program under WAC 182-505-0117;
- Alien emergency medical program under WAC 182-507-0110 through 182-507-0120;
- State-funded long-term care (LTC) for noncitizens program under WAC 182-507-0125; or
- Kidney disease program under chapter 182-540 WAC.
- Transfer of asset penalties under WAC 182-513-1363 do not apply to CFC applicants, unless the client is applying for long-term services and supports (LTSS) that are available only through one of the HCB waivers under chapter 182-515 WAC.
- Home equity limits under WAC 182-513-1350 do apply.
- Post-eligibility treatment of income rules do not apply if the client is eligible under subsection (1)(a) or (b) of this section.
- Clients eligible under subsection (1) (a) or (b) of this section, who reside in an alternate living facility (ALF):
- Keep a personal needs allowance (PNA) under WAC 182-513-1105; and
- Pay up to the room and board standard under WAC 182-513-1105 except when CN eligibility is based on the rules under WAC 182-513-1205.
- A client who receives CFC services under the health care for workers with disabilities (HWD) program under chapter 182-511 WAC must pay the HWD premium in addition to room and board under WAC 182-513-1105, if residing in an ALF.
- Post-eligibility treatment of income rules do apply if a client is eligible under subsection (1)(c) of this section.
- A client may have to pay third-party resources as defined under WAC 182-513-1100 in addition to the room and board and participation.
- PNA, MNIL, and room and board standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
- A client who is determined functionally eligible for community first choice (CFC) services under WAC 388-106-0270 through 388-106-0295 is financially eligible to receive CFC services if the client is:
-
WAC 182-513-1220 Community First Choice (CFC) - Spousal impoverishment protections for noninstitutional Washington Apple Health clients
-
WAC 182-513-1220 Community First Choice (CFC) - Spousal impoverishment protections for noninstitutional Washington Apple Health clients.
Effective February 25, 2023
- This section is effective through September 30, 2027.
- The agency or its designee determines eligibility for community first choice (CFC) using spousal impoverishment protections under this section, when an applicant:
- Is married to, or marries, a person not in a medical institution;
- Meets institutional level of care and eligibility for CFC services under WAC 388-106-0270 through 388-106-0295;
- Is ineligible for a noninstitutional categorically needy (CN) SSI-related program:
- Due to spousal deeming rules under WAC 182-512-0920, or due to exceeding the resource limit in WAC 182-512-0010, or both; or
- In an ALF due to combined spousal resources exceeding the resource limit in WAC 182-512-0010; and
- Meets the aged, blindness, or disability criteria under WAC 182-512-0050.
- The agency or its designee determines countable income using the SSI-related income rules under chapter 182-512 WAC but uses only the applicant's or recipient's separate income and not the income of the applicant's or recipient's spouse.
- The agency or its designee determines countable resources using the SSI-related resource rules under chapter 182-512 WAC, except pension funds owned by the spousal impoverishment protections community (SIPC) spouse are not excluded as described under WAC 182-512-0550:
- For the applicant or recipient, the resource standard is $2000.
- Before determining countable resources used to establish eligibility for the applicant, the agency allocates the state spousal resource standard to the SIPC spouse.
- The resources of the SIPC spouse are unavailable to the spousal impoverishment protections institutionalized (SIPI) spouse the month after eligibility for CFC services is established.
- The SIPI spouse has until the end of the month of the first regularly scheduled eligibility review to transfer countable resources in excess of $2000 to the SIPC spouse.
- A redetermination of the couple's resources under subsection (4) of this section is required if:
- The SIPI spouse has a break in CFC services of at least 30 consecutive days;
- The SIPI spouse's countable resources exceed the standard under subsection (4)(a) of this section; or
- The SIPI spouse does not transfer the amount under subsection (5) of this section to the SIPC spouse by the end of the month of the first regularly scheduled eligibility review.
- If the applicant lives at home and the applicant's separate countable income is at or below the SSI categorically needy income level (CNIL) and the applicant is resource eligible, the applicant is a SIPI spouse and is financially eligible for noninstitutional CN coverage and CFC services.
- If the applicant lives in an ALF, has separate countable income at or below the standard under WAC 182-513-1205(2), and is resource eligible, the applicant is a SIPI spouse and is financially eligible for noninstitutional CN coverage and CFC services.
- Once a person no longer receives CFC services for 30 consecutive days, the agency redetermines eligibility without using spousal impoverishment protection, under WAC 182-504-0125.
- If the applicant's separate countable income is above the standards under subsections (7) and (8) of this section, the applicant is not eligible for CFC services under this section.
- The spousal impoverishment protections under this section expire on September 30, 2027.
- Standards are found at www.hca.wa.gov/free-or-low-cost-health-care/i-help-others-apply-and-access-apple-health/program-standard-income-and-resources.
This is a reprint of the official rule as published by the Office of the Code Reviser. If there are previous versions of this rule, they can be found using the Legislative Search page.
Worker Responsibilities
For CFC only, if the client is active on SSI-related CN medical a program change is needed. The social worker/case manager will notify the financial worker of the start date and type of service via the 14-443 or 15-345. The financial worker will indicate CFC. This information is coded on the institutional care tab in ACES 3G or INST screen in ACES mainframe. This AU will be managed by DDA or HCS financial worker.
For clients not on Medicaid who are under age 65 and not on Medicare, a MAGI determination through the Healthplanfinder needs to be made first.
For clients who need classic Medicaid, determine eligibility under groups A, B, C, or D. Follow eligibility requirements for Medicaid.
If the client is not eligible under groups A, B, C, or D, determine eligibility under HCS Home and Community based (HCB) waivers . The financial worker will need to notify the social worker or case manager using the barcode 07-104, indicating that HCB waiver rules are needed for CN eligibility. If DDA is unable to authorize services under a waiver, send a 07-104 to HCS intake for an HCS waiver assessment.