June 19th, 2015Yakima WCOMO presentation
Community First Choice
2
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?
3
AGENDA
• Basic financial eligibility–How do I apply?–Eligibility criteria–What about transfer of assets
penalties?–Do I pay for services?
• Question and Answer
4
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
5
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?
6
• 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
7
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
8
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)
9
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
10
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)
11
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
12
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
13
• 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
What services are included in CFC?
14
• Additional Serviceso Community Transition Services
$850 per occurrence RCL continues to be the preferred program
o Training on managing caregivers On-line, booklets, DVDs
What services are included in CFC?
15
• 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?
16
• 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
17
• 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)
FINANCIAL ELIGIBILITY
18
• 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.
FINANCIAL ELIGIBILITY
19
• 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).
FINANCIAL ELIGIBILITY
20
• 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………..
FINANCIAL ELIGIBILITY
21
• 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
FINANCIAL ELIGIBILITY
22
• 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.
FINANCIAL ELIGIBILITY
23
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
24
• 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
PUTTING IT ALL TOGETHER
25
• 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.
PUTTING IT ALL TOGETHER
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
27
QUESTIONS?