1. Program Definition and Services

The Community First Choice (CFC) program in Washington is a Medicaid State Plan benefit that delivers long-term services and supports (LTSS) to eligible individuals. It allows participants to remain safely in their homes or communities rather than institutional settings. Services include:

• Personal Care & Household Assistance: Hands-on assistance with Activities of Daily Living (ADLs) (bathing, dressing, grooming, and mobility) and Instrumental Activities of Daily Living (IADLs) (meal preparation, light housekeeping, and essential shopping)
• Skills Acquisition & Health Tasks: Support designed to help clients learn self-care or household skills for greater independence, alongside health-related tasks safely delegated by a licensed registered nurse

2. Regulations

The program is governed by the following regulations:

• Washington Administrative Code (WAC): Sets forth the primary rules, eligibility thresholds, and service parameters for the Community First Choice program
• WAC Chapter 246-335: Governs the structural operational guidelines and license rules for the in-home care agencies that supply CFC caregivers
• Title 182 WAC: Standardizes Health Care Authority (HCA) state plan enrollment, Medicaid compliance, and ProviderOne portal billing framework

3. Licensing or Certification

To provide CFC services under an agency model, providers must secure a Home Care Agency License from the Washington State Department of Health (DOH). Furthermore, the agency must execute a Medicaid provider contract directly with the Department of Social and Health Services (DSHS) via ALTSA or DDA, and maintain an active billing profile with the Health Care Authority (HCA).

4. Responsible State Agency

The program is co-managed by three public entities: the Washington State Health Care Authority (HCA) oversees broad Medicaid funding and plan execution; the Department of Social and Health Services (DSHS) handles case management and provider contracting via the Aging and Long-Term Support Administration (ALTSA) or the Developmental Disabilities Administration (DDA); and the Department of Health (DOH) administers foundational home care agency licensing.

5. Application Process

Applicants must first complete the mandatory DOH In-Home Services Orientation Class, followed by submitting a Home Care Agency license application to the DOH. Once licensed, the business applies for a Medicaid long-term care provider contract with DSHS and registers its corporate profile inside the HCA's digital ProviderOne system.

6. Required Documentation

Providers typically need to submit:

• Secretary of State business registration (UBI number) and an organizational Type 2 NPI
• DOH Home Care Agency license and orientation attendance certificate
• A specialized CFC Policy and Procedure Manual detailing client rights, EVV tracking, skills acquisition tracking, and nurse delegation protocols
• Background check clearances via the DSHS Background Check Central Unit (BCCU) for all staff
• Verifiable commercial general liability insurance policy showing required state minimum limits

7. Timeline for Approval

Corporate setup and finishing the state licensing orientation require 3 to 5 weeks. The subsequent technical DOH licensing review and DSHS/ProviderOne Medicaid system enrollment phases generally take 3 to 4 months to secure complete approval.

8. Pre-Application Process

Prospective providers must complete structural foundation tasks prior to applying. They must establish their legal business entity with the Secretary of State, secure a state business license via the Department of Revenue, and obtain an EIN alongside a dedicated Type 2 National Provider Identifier (NPI).

9. Pre-Application Training

The agency’s named administrator and direct care supervisor must attend and pass the state's In-Home Services Orientation Class before a licensing packet will be processed. Practical training on the state-approved Electronic Visit Verification (EVV) system and ProviderOne portal is finalized during onboarding.

10. Additional Notes

• Unlike 1915(c) Medicaid waivers, CFC is an entitlement program under the Medicaid State Plan, if an applicant qualifies financially and meets the institutional level of care, they cannot be placed on a service waiting list
• Direct care staff (Home Care Aides) must complete 75 hours of state-approved training and pass the state certification exam within 365 days of their hire date
•  All personal care and attendant shifts delivered under the CFC program must use a state-compliant digital EVV application to verify tracking data like locations and times
• Unlicensed caregivers may perform certain health-related tasks (such as insulin injections or tube feeding) only if they have completed Nurse Delegation training and work under the explicit instruction of a supervising RN

Why Choose Waiver Consulting Group?

Starting or expanding your Medicaid waiver-funded agency can feel overwhelming, but it doesn't have to be. At Waiver Consulting Group, we simplify the process by guiding you through licensing, compliance, provider enrollment, policies & procedures, and regulatory approvals in any state.

With proven expertise, a structured process, and ongoing support, we take the guesswork out of launching your healthcare business. Whether you're a first-time entrepreneur or an established provider looking to expand, our team ensures you stay compliant, competitive, and fully operational.

To get started, click the link to request portal access