FAC Meeting Minutes June 2025

Loris shared that the rule came out in July 2024 and is complicated and confusing. Workgroups are working on different areas of the rule due to its complexity. The rule text is 1,000 pages and the rule areas are hundreds of pages each. The rule areas are:

• Advisory Groups
• Grievance System
• Incident Reports
• Person-Centered Plan
• Wait List
• Quality Measures
• Website
• Payment Rates

Questions:

• Hodan asked, “Will this rule make it easier or harder to find reliable caregivers?”
  • Easier, especially the parts about wait list and service times. They’re discussing developing more resources and providers.

• Yelena asked who the intended audience is for the 1,000-page document.
  • Lori is trying to find a plain language (or shorter) version but hasn’t found one. States are still trying to read and understand the rule. With the pause in communication from the federal government, we are still waiting and hoping someone will create a plain language version.

• Edison asked if is this a final rule?
  • Yes. If the federal government rescinds any part of the rule, we will need to figure out what pieces Washington would want to pursue.

• Hodan asked how are we planning to make sure these rules help immigrant and refugee families?
  • Not sure whether work groups have gotten to that level of detail yet, but Lori will take it back to the work groups to find out.

• Hodan asked “how will the 80/20 rule impact my child’s or family member’s care?”
  • Shouldn’t impact care. The goal is to make sure rates being paid for services are fair across the board.

• Hodan asked, “Will these changes affect the hours or services my family currently receives?”
  • No.

• Patti assumes the federal government decision involves doling out money. Are funds being provided?
  • There is no money from the federal government for these rules; it’s up the state to implement. If the federal government were to decide that because this was from the previous administration, and we don’t need to implement them, we still think they’re good rules. We would work with WA folks to figure out what makes sense for us. And we’d write it into our own state rule. If it requires funding, we’d go to leg. We can do some of these things without funding.

• Mia asked where do people report concerns?
  • Some of the grievance reporting systems we have on our website send people into a loop. We are trying to figure out how to improve the grievance process. We want processes that don’t just meet CMS’s rules but actually effect change.

Feedback:

• Hodan shared the following feedback:
  • “We need culturally responsive providers who understand our background and needs.”
    • Lori said that’s a great point. There aren’t enough resources and care givers out there and
  • “We need better language access when reporting issues or understanding forms.”
    • That’s part of the website transparency. People need to be able to contact us in various languages and ways.
  • “The systems (DDA, CDWA) don’t talk to each other well—we need better coordination.”
    • Lori agreed. With the new Reimagine DSHS, we hope to improve coordination between agencies.
  • “I want more transparency on how much of the funding goes to actual care.”
    • This is one of the goals of the payment rate workgroup.
  • Elderly folks trying to take care of their loved ones experience so many barriers.

• Michelle said she had the FAC give feedback on leg reports that informed where we might go with services. Basically, CMS said, if you’re going keep getting money from Medicaid, we want you to address these key issues. We have multiple workgroups that are looking at how to change the way we do services to improve them. But we’re bureaucrats in a bureaucratic system.

• Mia said, “I would like to see more oversight on the organizations we contract out to, to provide services for individuals on the program.”

Discussion of CDWA and DDCS partnership

In 2019, the state contracted with CDWA to become the legal employer. The contract is monitored by Sonya and her team to ensure the requirements are fulfilled and to maintain the relationship with CDWA.

The team does an annual audit. There are 58,000 IPs currently employed by CDWA, and they look at enough data that they can statistically make statements across the board.

The contract requires CDWA to provide monthly performance reports. The team gets 7 reports per month that they track. One performance standard is: 90% of IPs who are hired will get an “okay to provide care” date within 30 days of contracting. The intent is to get clients the service they need.

They also look at complaints and how they are handled/responded to.

Quality of calls is reviewed. CDWA provides a 2-question survey to every person who calls. They must be 80% of user satisfaction. Call volumes are monitored: how long does it take to answer the phones? How many dropped calls?

They also monitor how many people are recruited each month.

Melissa shared that DDCS meets with CDWA. Our executive leadership meets with CDE and CDWA to discuss bigger issues.

Feedback:

• Mia said communication with CDWA was a problem and she has recognized some improvements. Background checks were easier this year as well.
• Hodan is a parent of an adult daughter who is receiving services. Hodan’s concern is about the service coordinator. Some of the populations she works with are elderly and English is not their first language. The process is very complicated for them and time consuming. Hodan also want to see the same messaging across the board. When you walk into the CDWA office, people receive information that’s not accurate.
• Hodan understands case managers are overwhelmed. And often families will go straight to the case manager asking why the family hasn’t been paid yet. Even though the case manager has submitted all the correct documentation to CDWA.
• Mia said different coordinators give different information and it’s very confusing. She always asks them to take notes so she can see where the breakdown is
• Patti is extremely satisfied with the 2 CDWA reps that she works with. “They are very responsive to my emails and answer my questions, thoroughly, or advising what I need to do.  One thing I really like, is that these reps have been with me since 2019.”
• Edison hopes these improvements are helpful for everyone, not just fluent English speakers. He lost a provider because the provider was not fluent in English. CDWA was not able to communicate with someone who doesn’t speak English. This is an issue for so many people.
  • Sonya said Edison raises an excellent point. One of the things they’re looking at with CDWA in relation to hiring is that they’re breaking out IPs who say that English is their 2nd language and what hiring looks like for them. Extra effort has to go into the hiring because of that.
• Hodan said, “Language access is a human right. It is not optional — it should be a guaranteed part of how services are delivered. Families should not have to struggle or be the ones constantly trying to make communication happen. We ask that you please revisit and strengthen your language access supports for families, especially those who speak English as a second language. Clear, timely, and culturally appropriate communication is essential for equitable access to services.
  • CDWA makes information available in 8 different languages. All documents on their website are available in 12 languages and they’re looking at whether they need to expand that number. They’ve gone above what the contract requires.
• Edison said it will be helpful, when sending emails, to communicate who is the responsible party for certain things. Perhaps once a year we could communicate which agency is responsible for what.
  • Wonderful point. Sonya and Melissa will discuss the annual reminder of clarifying roles and where to go.
  • Mia suggested doing a video.

Questions

• Kimberly asked if most people take the survey after their phone call.
  • Sonya said 1,500 – 2,000 people take the survey every month.
• Kimberly asked: Do you look at retention from the recruitment that is required from CDWA?
  • Sonya said in the last 2 months, they started getting a report that lists information that will allow us to track retention.
• Ivanova asked if CDWA plans to provide folks English classes.
  • CDWA is not required to provide
• Michelle asked if it would be helpful to get an article out to our community partners about the benefits of taking the survey and how it has improved services? 
  • Yes. There’s always a benefit in sharing this information. Melissa said she’ll get in touch with their contact at Informing Families as well.