HCB Services (COPES, New Freedom, WMIP, PACE) Overview

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Revised May 13, 2013

Purpose: This section gives a brief overview of the HCB Services authorized by Home & Community Services (HCS). HCS Waivers are known as COPES, New Freedom and WMIP. Special instructions for New Freedom are found on the bottom of this page. PACE services can be authorized for individuals found functionally and financially eligible using the same rules as COPES, New Freedom and WMIP.

NOTE:

Clients must be aged, blind, disabled or presumptive SSI (GA-X) to receive HCS CN Waiver services.

HCS services cannot be authorized in a home setting, assisted living or enhanced adult residential center (EARC) under the disability life-unemployable program. Effective 11/1/2011 disability lifeline cash assistance ends but the state funded MCS medical will continue. (G01)

G01 can only be authorized by HCS in a nursing home setting, under a state funded adult family home or adult residential center (ARC) setting.

The Community Options Program Entry System (COPES), New Freedom and WMIP is a categorically needy (CN) waiver program that provides clients described in WAC 182-515-1505 with alternatives to placement in a medical facility. These alternatives include remaining in their home or placement in an alternate living facility (ALF) approved by the Home and Community Services (HCS) division. The goal of this program is to provide a safe level of care with maximum independence.

PACE is an HCS service program using eligibility rules under WAC 182-515-1505, the same as COPES. It is not a Waiver program.

Aging and Disability Service Administration’s (ADSA) delivery of services is implemented through a partnership of the Home and Community Services Division (HCS) and Area Agencies on Aging (AAA/Triple A). ADSA contracts with AAA to case manage, review, and reauthorize clients receiving in-home long-term care services administered by ADSA. HCS completes the initial comprehensive assessment and authorizes services for all new applications. Clients receiving in-home services are then transferred to AAA for continuing case management. HCS maintains the case management for clients in facilities

A Comprehensive Assessment, is the functional assessment (also called a CARE assessment) completed by Home and Community Services or AAA staff for all clients to determine initial or ongoing HCS Waiver/COPES eligibility.

A client attains Institutional Status when he/she receives HCS Waiver/COPES services.

Eligibility Determination Process
1. Determine both financial need and functional need.
2. Complete both eligibility determinations concurrently.
3. Both financial and functional eligibility must be determined before you authorize HCS Waiver/COPES.
Staff Who Make Eligibility Determinations:
1. The HCS social service staff assess the client’s HCS Waiver/COPES functional eligibility using the comprehensive assessment, determine functional eligibility, and authorize HCS Waiver/COPES services.
2. The FSS determines the client’s financial eligibility for medical care and post eligibility (determination of participation) to the HCS Waiver/COPES program.
3. The client authorized services must pay their responsibility toward the cost of care (service participation and room and board) to the provider or provider agency.

NOTE:

A client can be authorized to receive Hospice services while on COPES, New Freedom, WMIP and PACE. The HCS HCB program (is it usually COPES) is the priority program. Any participation is applied toward the COPES provider. For more information see Hospice.

New Freedom Instructions-Available in King Co.

The eligibility for New Freedom is the same as the COPES program. The program in ACES is L22 and the coding on the INST under HCBS is "C" the same as COPES. The case management is handled through the New Freedom contractor. Financial will be notified by the case manager/social worker of the change to New Freedom and the start date of the change. Currently New Freedom is available in King County. Information on New Freedom can be found in WAC 388-106-1400 through 388-106-1480. WAC 388-106-1410 explains who may be eligible for New Freedom.

The financial worker will:

Determine financial eligibility for long-term care services under the L22 program;