Washington Community First Choice: Washington 2026 Guide
Washington’s Community First Choice (CFC) is the main Apple Health (Medicaid) program for personal care at home and in residential settings for people who meet an institutional level of care. It is administered by the Department of Social and Health Services (DSHS) Aging and Long-Term Support Administration, often through Area Agencies on Aging.
This page explains who can get Community First Choice in 2026, what kind of help it pays for, how to request it, and how it compares with waivers and nursing home Medicaid. For the full statewide rules on income, assets, spouses and the look-back, see our Washington Medicaid guide.
Figures change periodically. Double-check current amounts before relying on them.
What Community First Choice is
Washington uses the federal 1915(k) option, so CFC is an entitlement: people who qualify receive services without a waitlist. The CARE assessment sets the number of hours. Care is provided by individual providers, often family members other than a spouse, or by home care agencies. CFC also covers personal care in adult family homes and assisted living, with the resident paying room and board.
Community First Choice pays for a worker to help with activities of daily living and the chores directly connected to them. When personal care is part of a state’s regular Medicaid program (the “state plan”), it is an entitlement: anyone who qualifies gets it, without waiver enrollment caps. Service lists are shorter than under a waiver, and an assessment decides the hours.
Who qualifies in 2026
Washington’s basic requirements are that a person must:
- be eligible for Washington Apple Health;
- meet nursing facility level of care through the CARE assessment;
- live at home or in a licensed residential setting; and
- need help with activities of daily living.
Financial rules. Community First Choice requires full Washington Medicaid. For many older adults, the regular Medicaid income limit is lower than the long-term care limit used for nursing homes and waivers. As a result, some people qualify for nursing home Medicaid but not for state plan home care, or only with a spend-down.
Washington’s 2026 special income level for long-term care is $2,982 a month, and the single-person asset limit is $2,000.
Washington’s 2026 long-term care Medicaid numbers, from our state guide:
| Item | 2026 figure |
|---|---|
| Income limit (applicant) | $2,982 a month (special income level) |
| Asset limit (single applicant) | $2,000 |
| Asset limit (couple, both applying) | $3,000 |
| Home equity limit | $1,130,000 |
| Spouse at home: resource allowance | The greater of $72,529 or half the couple’s assets, up to $162,660 |
| Spouse at home: monthly income allowance | Minimum $2,705 (from July 1, 2026) / maximum $4,066.50 |
| Personal needs allowance (nursing home) | $108.74 a month |
| Look-back period | 60 months (5 years) |
Couples. State plan programs often count a married couple’s resources together, without the full spousal impoverishment protections.
Services Community First Choice can cover
Help is authorized in hours a week or month, based on the assessment. Depending on need, Community First Choice can include:
- personal care
- relief care
- skills acquisition training
- personal emergency response systems
- nurse delegation
- assistive technology
- caregiver management training
- community transition services
Limits. Community First Choice is not 24-hour care and does not cover room and board or general housekeeping; skilled nursing and therapy are separate Medicaid services. A waiver can add services such as respite and home changes when needs grow.
How to apply for Community First Choice
Getting started usually looks like this:
- Contact the local Home and Community Services (HCS) office of DSHS Aging and Long-Term Support Administration, or the local Area Agency on Aging, and ask for a long-term care assessment.
- Apply for Washington Apple Health long-term care coverage through DSHS, online or on paper, if not already enrolled.
- A DSHS or Area Agency on Aging case manager completes the CARE assessment, which decides eligibility and the number of hours.
- Choose an individual provider (often a family member) or a home care agency, or a residential setting where that applies.
- Services start under the plan, with reassessments at least yearly.
Tips for the paperwork. Keep a folder of copies, and log every call with the date and name. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Supervision needs, confusion and falls matter as much as hands-on help. A denial notice explains the fair hearing process and its deadline.
Waiting lists and timing
CFC has no waitlist. Separately, the MAC and TSOA programs have paused new enrollment since December 1, 2025.
Because it is an entitlement, state plan personal care should not have an enrollment waiting list. Even so, the application, the assessment and finding an aide can each add weeks.
How it relates to nursing home Medicaid
Community First Choice serves people at home, and many recipients would not meet a nursing home level of care. When needs grow beyond it, a waiver or nursing home becomes the next step. Nursing home coverage uses different, often more generous income rules.
Getting ready for Community First Choice
Most families come to Community First Choice during a change: a fall, a hospital stay, or a caregiver who can no longer keep up. Planning a little ahead makes each step easier. Start by writing down what help is needed each day, who provides it now, and what would happen if that person were unavailable for a week. That list supports the assessment and shows where paid help would make the biggest difference.
On the financial side, gather recent bank statements, income letters such as Social Security and pension notices, health insurance cards, and proof of age and residence in Washington. Keep older statements too: if a waiver or nursing home becomes necessary, the five-year look-back applies. A durable power of attorney and health care directive, signed while the person can still make decisions, let a family member handle applications and appeals without court involvement.
Check in on how the arrangement is working every few months; a reassessment can adjust hours or services. Notes on falls, hospital visits and new diagnoses make later reviews easier.
Tips for families
Before the assessment, list every task the person needs help with, how often, and how long it takes. Programs differ on whether relatives can be paid and what training is needed. If hours seem too low, a written decision and a fair hearing are the remedy.
Working with a Certified Medicaid Planner is often the fastest way through Community First Choice. A planner who handles Washington cases regularly can spot eligibility problems before Washington DSHS does, organize the records and help plan around any wait. Fees vary: roughly $500 to $6,000 for application help, $2,500 to $15,000 or more for full planning, and $150 to $600 an hour for advice.
Related pages
- Washington Medicaid guide
- Washington COPES Waiver
- Washington Medicaid Personal Care
- In-home care and Medicaid
- Activities of daily living
- Consumer-directed care
- Paid family caregivers
- HCBS waivers explained
Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.