The Community First Choice Medicaid Program Has Come To Washington State—What You Need To Know, Part II

Posted on: Aug 10, 2015

The Community First Choice Option (CFC) program went into effect in Washington State on July 1. In Part I of this blog last month we discussed what the program is and the various kinds of services it offers. CFC allows the State to provide services to qualifying Medicaid beneficiaries that allow them to receive care in a community setting rather than an institutional setting.
This month, we provide details on who is eligible for the CFC program, and information about the costs associated with CFC.
Eligibility
Generally, you are eligible for CFC if you meet both financial AND functional criteria for the program.
Functional eligibility is based on your physical needs. You must, due to some disability or impairment, require help with some or all of your Activities of Daily Living (ADL) like bathing, dressing and medication management. Washington’s Department of Social and Health Services (DSHS) conducts an in-person assessment of your capability for self-care known as the Comprehensive Assessment Reporting Evaluation (CARE) assessment.
To meet the financial eligibility requirements, you must be eligible for a categorically needy (CN) or Alternate Benefit Plan (ABP) scope of care, delivered at home or in the community (other than in a Skilled Nursing Facility). Eligibility is based on both your income and financial resources. DSHS will determine your total “income” based on the money you receive on a monthly basis such as a pension or Social Security benefits. If your income is too high to qualify as CN, you could still be eligible for benefits under a Home and Community Based waiver for the COPES program.
Your “resources” are determined by taking a financial “snapshot” of the countable assets available to you on the first day of the month. For most people, countable resources must total at or below $2,000 on the first day of each month. Assets like your home, a vehicle and a prepaid burial plan are not countable resources. It may be possible to preserve some non-countable resources or a portion of the proceeds from their sale. The sooner you plan for this, the more options are available. Preserving assets requires a strategy you should discuss with your elder law attorney.
Cost
If you receive only CFC services, delivered in your home, then you do not have to pay for services. If you live in an assisted living facility (ALF), you pay for only your room and board. If you receive both CFC and a waiver service like COPES in an ALF, then you might be required to pay towards your services, less a monthly personal needs allowance.
There are many special considerations when your care needs are such that you wish to qualify and remain eligible for CFC benefits while ensuring your spouse is not impoverished and your assets are preserved from the State’s lien. Thus it is worthwhile to discuss your specific situation and options for receiving benefits and preserving assets with a skilled elder law attorney like those with the Elder Law Group. Please call us today at (509) 468-0551 for help in determining CFC benefits available to you and your family.

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