Community First Choice Option

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The Health Care Authority in conjunction with the Department of Social and Health Services (DSHS) intends to submit Medicaid State Plan Amendment (SPA) 16-0031 to make amendments to the Community First Choice Program SPA 15-0037 that was initially approved by CMS effective July 1, 2015.  

SPA 16-0031 will amend the Community First Choice program to:

  • Clarify language for personal care providers regarding state and federal background checks.
    • A state background check must be completed prior to contracting
    • A federal background check must be completed within 120 days of the provider being hired.
  • Remove the link to the rate schedule listed on Attachment 4.19-B page 49.
  • Add  provider types  eligible to provide the following services:
    • Voluntary training on how to select, manage and dismiss attendants
    • Community Transition
    • Assistive Technology
  • Expand the scope of the “voluntary training on how to select, manage and dismiss attendants”.  Currently this service is provided through self-study materials. Upon approval from CMS, participants who employ and manage multiple care providers may choose to receive training directly from listed provider types.
  • Expand the scope of the Backup System service to receive federal matching funds for bed hold retainer payments to residential providers during a participant’s short term hospital or nursing home stay. 
  • Remove references to the Social Service Payment System.
  • Increase the fiscal year monetary limit available to participants to $550.00 for the purchase of Assistive Technology and Skills Acquisition Training. 
  • Clarify that the scope of assistive technology services includes assistive equipment that increases the individual’s independence or substitutes for human assistance.

Please view amendments to this plan here.


The Affordable Care Act established the new Medicaid entitlement state plan option, Community First Choice Option (CFCO), which gives clients more service options and allows the state to get a higher federal Medicaid match rate. 

In Engrossed Substitute House Bill 2746 and Substitute Senate Bill 6387, the 2014 Washington State Legislature directed the Department to seek stakeholder input on program and system design for CFCO.  The federal regulation requires establishment of a stakeholder council, the majority of which is comprised of individuals with disabilities, elderly individuals, and their representatives.  The CFCO entitlement program is intended to refinance personal care services offered through the state plan and waiver programs. 

Program Information

Jacqueine Echols
Community First Choice Program Manager
DSHS | Aging and Long-Term Support
Home and Community Services Division
Phone: 360-725-3216
Email: jacqueine.echols@dshs.wa.gov

Nicole Fergason
Community First Choice Program Manager
DSHS | Developmental Disabilities Administration

Central Office
Phone: 360-725-3525
Email: nicole.eppich@dshs.wa.gov