PROGRAM QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE
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QUESTIONS AND ANSWERS
ON THE COMMUNITY FIRST CHOICE
PROGRAM
COLUMBIA LEGAL SERVICES JANUARY 2020
THIS PAMPHLET IS ACCURATE AS OF ITS DATE OF Disabilities Administration has five 1915(c)
REVISION. THE RULES CHANGE FREQUENTLY. waivers which include Basic Plus, Core,
Individual and Family Services, Community
1. What is Community First Choice (CFC)? Protection, and Children’s Intensive In-home
Behavior Support.
CFC is a Medicaid program offering personal
care and other services. The program was To be functionally eligible for CFC
established by the Affordable Care Act (ACA) authorized by the Aging and Long Term
under 1915(k) of the Social Security Act and is Support Administration (ALTSA), you must
administered by the Washington State be eligible for the level of care required in a
Department of Social and Health Services nursing facility as defined in WAC 388-106-
(DSHS). Offering personal care and other 0355, which is the same level of care as the
services under CFC allows DSHS to provide a COPES program.
more extensive benefit package to support
clients in community settings. CFC is To be functionally eligible for CFC
intended to promote choice, flexibility, and authorized by the Developmental Disabilities
community care over institutional care. For Administration (DDA), you must be eligible
qualified individuals, CFC offers personal for the level of care required in an
care services, skills acquisition training, Intermediate Care Facility for Individuals
assistive technology, personal emergency with Intellectual Disabilities (ICF/ID) as
response systems, and a few other services defined in WAC 388-845-0070, 388-828-3060,
that help clients remain in community and 388-828-3080 or a nursing facility as
settings. defined in WAC 388-106-0355.
To be eligible, you must meet two types of 2. How do I apply for CFC?
criteria: (1) financial eligibility and (2)
functional eligibility. You can apply for CFC in one of three ways:
You are financially eligible for CFC if you are • If you are a current Medicaid
eligible for categorically needy (CN) or recipient, contact Home and
Alternate Benefit Plan (ABP) scope of care in Community Services for a social
the community. This includes both non- service intake. Please see Appendix A
institutional medical coverage groups and for contact information.
CN coverage through a 1915(c) home and
community based waiver. COPES, is the • If you are not currently receiving
1915(c) waiver offered by Home and Medicaid, and are under age 65 and
Community Services. The Developmental not entitled to Medicare, apply onlineQUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
through the Health Benefit Exchange benefits based on income, known as
at www.wahealthplanfinder.org Washington Apple Health MAGI Medicaid.
MAGI stands for Modified Adjusted Gross
• If you are not currently receiving Income and is a way for individuals to obtain
Medicaid and are age 65 and older, or government-paid healthcare benefits,
on Medicare, apply online at depending on income.
www.washingtonconnection.org The CN and ABP benefit package includes
or by submitting a paper application CFC services for those eligible. A disability
to a local DSHS Home and determination is not required for an
Community Services (HCS) office. individual receiving MAGI based coverage.
The website for downloading a paper 4. When do CFC services begin?
application [Form HCA 18-005 (3/14)
Washington Apple Health Application for CFC eligibility begins on the date DSHS
Long-Term Care/Aged, Blind, Disabled authorizes the service. It is not retroactive
Coverage] is and will not cover services provided before
http://www.hca.wa.gov/medicaid/forms/ the date of the authorization. Within 60 days
Documents/18-005.pdf. You may also pick from the date of the completed assessment,
up the application form at a DSHS office. A you must sign and return a copy of a
paper application may be returned to PO Box document called the “Service Summary” in
45826 Olympia, WA 98504 or to your local order for your services to continue. This
Home and Community Service (HCS) office. document outlines the services and supports
To find the right HCS office, call 1-800-422- you are receiving. It is your official approval
3263 or us the online tool to find the HCS for the services being provided to you.
office in your county.
https://www.dshs.wa.gov/altsa/resources 5. How are income and resources
determined for the purpose of CFC?
3. How is CFC eligibility determined?
To receive CFC services both your income
As noted in Question 1, there are two parts to and your resources must be within set limits.
eligibility. First, you must be financially Some CN or ABP programs have no resource
eligible for a categorically needy (CN) or an test, such as the MAGI programs or
Alternate Benefit Plan (ABP) Medicaid Healthcare for Workers with Disabilities
program, as described in WAC 183-503-0510. (HWD). Most programs based on aged, blind
Second, you must be functionally eligible, and disability criteria have a $2,000 resource
which means you need help with certain limit for a single person.
activities of daily living because of a physical
or cognitive impairment. Some examples In counting your resources for a month,
include help with bathing, dressing, hygiene, DSHS essentially takes a snapshot of your
and medication management. To determine resources as of the first moment of the first
eligibility and the level of help needed, an in- day of the month. Whatever resources exist
person assessment and interview is at that exact moment are the resources
conducted by the department to evaluate counted. Resources typically include such
your ability to care for yourself. things as real estate, funds in bank accounts
(but not including this month’s income) and
Under the Affordable Care Act, individuals stocks. Funds from a payment that counted
under age 65 may be eligible for healthcare as income last month will count as resources
PAGE 2 JANUARY 2020QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
this month if you still have them as of the health-care/apple-health-medicaid-
first of this month. Not all resources count coverage/eligibility
for purposes of determining resource
eligibility (see Questions 10 through 13 7. What level of resources can I have and be
below). eligible for the CFC program?
In counting your income for a month, DSHS Your countable resources must be at or below
looks at what you received that month. Income $2,000.00. For those who are receiving CFC
typically includes such things as Social personal care services through a MAGI plan
Security, VA benefits, pension payments, and or through the HWD program, there is no
wages, in the month they are received. resource test.
The income and resource standards for 8. How are my spouse’s income and
Medicaid programs are adjusted yearly and resources considered?
can be found here:
http://www.hca.wa.gov/free-or-low-cost- Your spouse’s income and resources are
health-care/apple-health-medicaid- counted to determine whether you are
coverage/eligibility financially eligible for CFC.
a) Countable income in the name of the
6. Am I income eligible for the CFC CFC eligible person and their spouse
program? must be at or below the 2-person
categorically needy income level
If you are an SSI-related person, your (CNIL) of $1,175, if you are living in
countable income must usually be at or below your own home. If you live in an
the 1-person categorically needy income level alternate living facility, such as an
(CNIL), which is $783 as of January 1, 2020. adult family home or assisted living
facility, the income standard is the
If you do not meet the CFC income eligibility department paid daily rate, but in no
rules, you will then be considered under the case more than $2,349 (as of the date of
Home and Community Based waiver rules, this document); and
such as COPES. For eligibility information on
the COPES program, see Questions and b) Combined resources must be at or
Answers on the COPES Program, which is below the state resource standard for a
available on the website married couple which is $3,000.00 for
www.washingtonlawhelp.org. initial eligibility.
If you are an SSI-related person residing in an 9. Do I have to pay for CFC services?
Alternate Living Facility (ALF), the income
limit is higher. A person residing in an ALF • If you are receiving CFC only, and you
has a higher income standard, but will have live at home, you do not have to pay
to pay towards the cost of care. for your services.
If you are on a MAGI or HWD program the • If you are receiving CFC and HCB
income levels can be found at: waiver services, such as COPES, you
http://www.hca.wa.gov/free-or-low-cost- may have to pay toward the cost of the
services. The amount you pay is based
COLUMBIA LEGAL SERVICES PAGE 3QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
on your income, marital status, and application for DSHS-administered long-term
any allowed deductions. For care services filed before May 1, 2006; or (2)
information on how DSHS determines the recipient’s spouse or the recipient’s child
how much you have to pay, see who is under 21 or blind or disabled resides
Questions and Answers on the COPES in the home. The disability criteria for this
Program which is available on the purpose are the same as those used for Social
website www.washingtonlawhelp.org. Security Disability determinations.
• If you are receiving CFC only, and live Even when a home is exempt, a married
in an alternate living facility (ALF), Medicaid applicant or recipient may wish to
you pay room and board to the transfer his or her interest to their spouse.
facility. Such a transfer may be made to prevent
future recovery of Medicaid costs from a
• If you live in an ALF, and your Medicaid recipient’s estate (see Question 15)
countable income is above the CNIL or to make it easier for the spouse to sell or
for your household size, you are otherwise dispose of the home. But, such a
allowed to keep a $70 monthly transfer is not always a good idea. It may, for
personal needs allowance and you example, have adverse tax or other
must pay the facility the remainder of consequences in some cases. Before making
your countable income. such a transfer, you should consult with a
lawyer familiar with Medicaid rules and
NOTE: If you are a functionally eligible SSI- estate planning.
related person who is working, , you should Note: The proceeds from the sale of an
contact your Public Benefit Specialist (PBS) to exempt home are also exempt if they are
determine whether the Healthcare for used to purchase a new exempt home within
Workers with Disabilities (HWD) program is three months of receipt.
more beneficial than other SSI-related
programs. The HWD program has no income 11. When is a car exempt?
limit and no asset test.
One car is exempt, no matter how much it is
10. When is a home exempt? worth, if it is used for transportation either
for the CFC recipient or for a member of the
A home (which may be a house and recipient’s household.
surrounding land, a condominium or a
mobile home) may be an excluded resource. 12. When can burial funds and burial spaces
The exclusion applies if the CFC recipient be exempt?
lives in the home, or is temporarily absent but
intends to return to it. It also applies as long A burial fund of $1500 for an individual (and
as the recipient’s spouse or, in some cases, a an additional $1500 for a spouse) may be
dependent relative, continues to live in the claimed as exempt if set aside in a clearly
home. designated account to cover burial or
cremation expenses. If you have a life
The exemption does not apply to a home in insurance policy that is claimed as exempt,
which the CFC recipient has an equity then the face value of the life insurance will
interest of more than $595,000, unless one of count as part of your burial fund. So, for
the following exceptions applies: (1) the example, if you have an exempt life insurance
recipient is receiving services based on an with a face value of $1000, then only $500
PAGE 4 JANUARY 2020QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
may be exempted in a designated account for State of Washington paid for the recipient’s
burial expenses. care. Whether or not Medicaid is entitled to
recover depends on the type of services you
An irrevocable trust for burial expenses or a received and the dates when the services
pre-paid burial plan may be claimed as were provided to you. See Estate Recovery
exempt as long as it does not exceed for Medical Services Paid for by the
reasonably anticipated burial expenses. The Statewhich is available on the website
value of such a trust or plan will count www.washingtonlawhelp.org.
against the exemption for burial funds or life
insurance. Recovery will be delayed if, at the time of
death, you have a surviving spouse,
Burial spaces for CFC recipients and registered domestic partner, or surviving
immediate family members are exempt no child who is under the age of 21 or blind or
matter how much they are worth. disabled.
13. When can household goods and personal The DSHS estate recovery claim only applies
effects be exempt? to property owned at death by a recipient. No
claim can be made against property solely
Household furniture and other household owned by a spouse or child. This may be an
goods, as well as clothing, jewelry and important reason to consult a lawyer familiar
personal care items are exempt regardless of with CFC and Medicaid rules about
value. permissible transfers of property.
14. Can I transfer resources without 16. Do I still pay Medicare Part D Co-
affecting CFC eligibility? Payments if I am on CFC? Do I have to pay
Medicare Part B monthly premiums,
Transfer of asset rules (which can be found in deductible, and co-pays? What about
WAC 182-513-1363) do not apply to a person Medicare Part A?
receiving CFC only. The transfer of an asset
may affect eligibility for a HCB waiver (such Once you are on CFC, your Medicare Part B
as COPES), or nursing facility placement, if monthly premiums, Part B co-payments, Part
the transfer is made within 5 years of needing B deductible, Part A deductible, and Part A
that service. For more information about coinsurance for hospital or nursing home care
transfers that may affect eligibility for HCB are covered or cannot be collected, but the
waiver services or nursing home placement, effective date may vary. If you have
see questions, you can ask your DSHS Public
Questions and Answers on the COPES Benefit Specialist.
Program and Questions and Aswers on
Medicaid for Nursing Home Residents which Medicare Part D is the prescription drug part
are available on the website of Medicare. If you receive CFC services
www.washingtonlawhelp.org. only, you are still responsible for Medicare
Part D co-payments. However, if you are
15. Will CFC payments result in a lien or also on an HCB Waiver such as COPES,
claim against my estate? Medicare D co-payments are waived. You can
ask to receive both CFC and HCB Waiver
DSHS may be entitled to recover, from a services. If you are eligible and decide to
Medicaid recipient’s estate, the amount the receive an HCB Waiver service, your
COLUMBIA LEGAL SERVICES PAGE 5QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
Medicare D co-payments will be waived. hospital, to a community based
For more information about why going on setting
COPES may help you, see Questions and
Answers on the COPES Program and • Training on how to hire, manage, and
Medicare Savings Programs: Help Paying for dismiss personal care providers
Medicare Costs.
18. Can I get help with the application
17. What types of services does CFC process?
provide?
Many people need help applying for CFC or
When you apply for services, a case manager Medicaid. Often there are family members or
will be assigned to you and will work with friends, or staff members of a hospital or
you to individually assess your care needs nursing home or other agency, who are able
and discuss your goals and preferences. The to help. Help is also available from DSHS
case manager will explain the services that staff, especially for people who have physical
you are eligible to receive and you will or mental impairments that make it hard to
choose the services you wish to receive from get through the application process on their
those available to you. own.
The CFC program includes the following If you need help in the application process
services: from DSHS, you or someone else should tell a
• Personal care in community based DSHS representative that you need help.
settings DSHS rules require what are called
“necessary supplemental accommodation
• Relief care for clients in their own services” when they are needed. These
home when a caregiver is out or needs services include help filling out forms and
a break help finding information or papers you need.
• Skills acquisition training to help CFC rules are complicated. Before taking
people perform their personal care steps you don’t understand, you should get
tasks independently individualized legal advice.
• Personal Emergency Response PLEASE SEE ATTACHMENT A, PROVIDED
Systems (PERS) for qualified clients to BY DSHS, FOR HOW TO REQUEST A
summon help in case of a fall or an LONG-TERM CARE (LTC) ASSESMENT
emergency
CFC 01-2020
• Assistive technology items
recommended by a therapeutic COLUMBIA LEGAL SERVICES
provider that substitute for human
101 Yesler Way, Suite 300, Seattle,
assistance or increase independence
WA 98104
• Community transition services are
available to clients who wish to
relocate from an institutional setting,
like a skilled nursing facility or
PAGE 6 JANUARY 2020QUESTIONS AND ANSWERS ON THE COMMUNITY FIRST CHOICE PROGRAM
Attachment A
How to Request a Long-term Care (LTC) Assessment
Call and schedule an assessment through the DSHS Central intake lines. Social Service central
intake lines are divided by Regions in the State of Washington. This is used to request a social
service assessment for home and community services (in-home care, care in a residential facility,
nursing facility coverage).
• Region 1 HCS-Pend Oreille, Stevens, Ferry Okanagan, Chelan, Douglas, Grant, Lincoln,
Spokane, Adams, Whitman, Klickitat, Kittitas, Yakima, Benton, Franklin, Walla Walla,
Columbia, Garfield and Asotin: 1-866-323-9409 or FAX 509-568-3772
• Region 2 North HCS - Snohomish, Whatcom, Skagit, Island Counties 1-800-780-7094 or FAX
425-977-6579.
• Region 2 South HCS - King County 206-341-7750 or FAX 206-373-6855
• Region 3 HCS- Pierce, Kitsap, Thurston, Mason, Lewis, Grays Harbor, Pacific, Cowlitz,
Clark, Clallam, Jefferson Counties 1-800-786-3799 FAX 360-586-0499
You may find also find this information in the Apple Health Manual, Long-term Care
Applications: http://www.hca.wa.gov/free-or-low-cost-health-care/program-
administration/applications-ltc
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