Washington State Community First Choice (CFC)

Program Description

The Community First Choice (CFC) program is an innovative Washington state Medicaid program that provides assistance services to aging residents who’d otherwise require nursing home placement. Assistance may be provided in any of the following settings: the participant’s home, an assisted living facility, adult residential care, or an adult family home. 

The personal/attendant care provided under CFC can be self-directed by the program participant. This means they have the option of choosing who provides their care services. Family members are permitted to be hired as care providers. However, to be clear, spouses cannot be hired to provide care. Family members will receive the Medicaid approved rate for non-medical care providers in Washington, which is approximately $15.50 per hour.

Washington’s Department of Social and Health Services (DSHS) has made the Community First Choice Option available through Washington State Medicaid (also known as Apple Health). CFC is an entitlement program, which means there are no waitlists. Anyone who is eligible for this program is able to receive services.

Eligibility Guidelines

Interested residents can participate in CFC if they can demonstrate the required level of care needed and they have limited financial resources.

General Requirements

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.

Financial Requirements

CFC services can be obtained either through the COPES Medicaid Waiver or through Regular Medicaid (Apple Health).

Income Limits: COPES Medicaid Waiver
For 2024, individual applicants must have a gross monthly income under $2,829. This amount is three times the current Federal Benefit Rate (FBR), and is updated annually by the federal government.

For applicants who are married but their spouse is not also applying for benefits, income up to $3,853.50 per month (in 2024) may be transferred from the applicant spouse to the non-applicant spouse. This is to ensure the non-applicant spouse can support themself, but it also helps to lower an applicant’s countable income. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.

For couples when both spouses are applying, the monthly income limit is $5,658 — $2,829 for each spouse.

Income Limits: Regular Medicaid
Single applicants are limited to 100% of the Federal Benefit Rate. In 2024, this is equal to $943. For a couple with both spouses applying the limit is $1,415.

Asset Limits
Asset limits are the same for both pathways. Individuals cannot have more than $2,000 in total assets. (Unlike income, this figure does not change annually). The cap on the assets also depends on the applicant’s marital status. When both spouses are applying, the asset limit is $3,000.

For couples when only one spouse is applying, the non-applicant spouse (often called a community spouse) is able to retain up to $68,301 in assets. This is to prevent the non-applicant spouse from becoming impoverished.

In addition, some assets are not counted toward Medicaid’s asset limit, which includes the value of one’s home, so long as the applicant or their spouse is living in it, and the equity value of the home is not more than $1,071,000. Other exemptions include a vehicle, an irrevocable burial trust, and household furnishings and items.

Over the Financial Limits?

Married individuals and persons with finances over these limits should consider finding Medicaid planning assistance. Persons in these situations still may be eligible for Medicaid, but just require financial expertise to help them allocate their resources appropriately. Learn more.

Benefits and Services

CFC 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 the activities of daily living (ADLs) and the 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, and ostomy care
• Housework
• Transportation assistance
• In-home respite care
• Skills acquisition training / Assistive technology
• Training for the consumer direction option (how to choose and manage caregivers, etc.)
• Personal emergency response systems
• Community transition services

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

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 CFC should contact the local aging services organization for their county.