June 19 th, 2015 Yakima WCOMO presentation 1 Community First Choice

June 19th, 2015Yakima WCOMO presentation

Community First Choice

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AGENDA

• History

• Overview of Community First Choice (CFC)–What is it?–What services does HCS offer today?–What will it look like in the future?–How am I functionally eligible for CFC?–What services are included in CFC?

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AGENDA

• Basic financial eligibility–How do I apply?–Eligibility criteria–What about transfer of assets

penalties?–Do I pay for services?

• Question and Answer

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HISTORY

• The Affordable Care Act (ACA) added federal authority for CFC under Section 1915(k) of the Social Security Act.

• Legislation in WA passed in June of 2014o ESHB 2746o SSB 6387

• CFC workgroup met between April & October of 2014 to design the benefit model

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CFC supports our Strategic Plan

• A richer benefit provides needed supports to remain in the community• Relocation out of institutional care is supported• Supports client choice, flexibility, and

independence• CFC helps build a sustainable future by

providing services that leverage federal funds while allowing clients to manage their own care needs

HISTORY– Why CFC?

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• Start date is 07/01/2015• CFC is a state-plan service – This means it is available in the benefit package of

most regular Apple Health medicaid programs• Must meet Institutional level of care – This means you must be assessed and meet the

functional requirements of the program.

GENERAL REQUIREMENTS

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CURRENT

OUR CURRENT SYSTEM

Institutional Home & Community

Based

Entitlements (State Plan)Waivers

(Other Medicaid)

Home & Community

Based

Medicaid Personal Care• Personal Care

Waiver Svcs• Personal care• PERS• Equipment• Assistive Tech• Home Mods

• Respite• Therapies• Habilitation• Employment

Support• Other

Nursing Facilities or ICF/ID

Current: Client is eligible for one or the

other

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FUTURE

CFC IN OUR FUTURE SYSTEM

Entitlements (State Plan)

Institutional Home & Community

Based

Home & Community

Based

MPC orCommunity First Choice• Required Services

• Personal Care• PERS Systems• Skills Acquisition Training• Caregiver Management Training

• Optional Services• Community Transitions• Assistive Technology

Waivers• Ancillary Services• Wrap-Around to CFC Services

Nursing Facilities or ICF/ID

New: Clients may be on both programs!

Waivers(Other Medicaid)

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Program Options• New Program Option Choices:–MPC • MPC services will not change, but functional eligibility

will change

– CFC• New State Plan service• Primary program for most clients• The main source for personal care for most clients

– CFC + Waiver (COPES)• Clients may be on both CFC and a waiver• This is new for HCS

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State Plan Eligibility• Medicaid Personal Care– Client does not meet institutional level of care– Client is eligible for a CN medicaid program

(excluding waiver programs)

• Community First Choice Only– Client meets institutional level of care– Client is eligible for a CN medicaid programs

(including waiver programs)

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Waiver Eligibility• Community First Choice + Waiver Services–Must be functionally & financially eligible for

waiver• A new application may be required (HCA 18-005 form)

–Clients must meet age (65+) or disability requirements to access waiver services.–Why would someone need or want a waiver?• They require a service not available in CFC• They have an income over standard for a non-

institutional medicaid program.• To continue waiver eligibility, client must receive a

waiver service every month

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What services are included in CFC?

• Monthly Serviceso Personal Care

In-home with IP, Agency, or Relief care providers

Residential Care – AFH or ALFo Skills Acquisition Training

May use in-home care hours for this serviceo PERS Systems

Client must meet WAC criteria

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• Limited Annual Serviceso $500 per fiscal year per client

Fiscal year is July 1 – June 30

o Assistive Technologyo Skills Acquisition Training

• Additional Serviceso Community Transition Services

$850 per occurrence RCL continues to be the preferred program

o Training on managing caregivers On-line, booklets, DVDs


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• Additional Serviceso Community Transition Services

$850 per occurrence RCL continues to be the preferred program

o Training on managing caregivers On-line, booklets, DVDs


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• In your own home with a paid caregiver• In a residential setting:–Adult family home (AFH)–Adult residential center (ARC)–Assisted Living (AL)*–DDA group home

– *Currently MPC services are only available in an ARC or AFH – CFC includes more settings.

Where can I get CFC services?

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• How do I apply for CFC?– Recipients: No application required - just need to

schedule an assessment through our intake process

– Applicants: Must file an application - HCA 18-005 form (just like today)

– Can apply online at www.washingtonconnection.org

– (see handout)

FINANCIAL ELIGIBILITY

http://www.washingtonconnection.org/

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• How am I eligible?– Must be eligible for Washington Apple Health

categorically needy (CN) or alternative benefit plan (ABP) scope of care

– This includes clients who access CN coverage through an HCS or DDA waiver.

• Not eligible for CFC:– Medically needy (MN)– Alien emergency medical (AEM)


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• If I’m already eligible for non-institutional medicaid:– No transfer of asset rules apply – No post eligibility treatment of income (PETI)

• If I need to apply for COPES:– Transfer of asset rules DO apply– Must pay towards cost of services for both CFC

and waiver services.


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• Cannot have a home with equity above the limit ($552,000)

• Must still pay Room & board (rent) in residential settings (for example an adult family home or assisted living).


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• Income and Asset limits– Income: the limit for each specific program

applies– Resources: • Non-institutional SSI-related medicaid:

– Single $2000– Married couple $3000

• Institutional SSI-related medicaid:– Single $2000– Marred couple $53,016 (+ the $2000) BUT………..


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• Spousal Impoverishment (SI) and CFC– SI protects the income and assets of a community

spouse– A community spouse is the husband or wife of

someone received long-term services & supports– Historically SI only applies to people in a nursing

facility or receiving waiver services– In the CFC world, SI applies to a married person is

is found functionally eligible for CFC


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• Spousal Impoverishment (SI) and CFC– What does this mean?• Current ‘Classic’ medicaid rules require a couple to

spend down resources to $3000 or less• With CFC, the applicant can now have $2000 and the

spouse can have the higher resource limit of $53,016• Current ‘Classic’ medicaid rules require we count both

persons income in the eligibility determination• With CFC, we only count the applicant’s income using

name on check rules.


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To sum up:• CFC becomes the state’s priority program to deliver

long-term services & supports• Most services in the HCS waivers will be moved to

CFC • You can receive CFC by itself; or• You can receive BOTH a waiver and CFC for example:– Wellness Education through the waiver– Personal Care through CFC

PUTTING IT ALL TOGETHER

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• If you are eligible to receive medicaid coverage today, you have met the eligibility criteria for CFC – you just need to have care needs that meet the functional criteria

• If you are not eligible for a regular medicaid program due to income or resource rules, you may get another chance using spousal impoverishment rules


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• Transfer penalties do not apply to non-institutional Apple Health programs so would not apply to CFC

• If your income is too high and you can only access CFC by using institutional waiver eligibility, transfer penalties do apply

• CFC provides a greater choice of settings and person-centered care plans.


HCS & AAA Contact:Tracey Rollins, HCS(360) [email protected]

DDA Contact:Jaime Bond, DDA(360) [email protected]

Financial Services Contact:Rob Peters, Financial Services(360) [email protected] Site:

https://www.dshs.wa.gov/altsa/stakeholders/community-first-choice-option

Or • Go to www.dshs.wa.gov/altsa• Choose: “Stakeholders”• Choose Community First Choice

Program Management Team

mailto:[email protected]







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QUESTIONS?

Documents

June 19 th, 2015 Yakima WCOMO presentation 1 Community First Choice