June 19 th, 2015 Yakima WCOMO presentation 1 Community First Choice

AGENDA History Overview of Community First Choice (CFC) – What is it? – What services does HCS offer today? – What will it look like in the future? – How am I functionally eligible for CFC? – What services are included in CFC? 2

AGENDA Basic financial eligibility – How do I apply? – Eligibility criteria – What about transfer of assets penalties? – Do I pay for services? Question and Answer 3

HISTORY The Affordable Care Act (ACA) added federal authority for CFC under Section 1915(k) of the Social Security Act. Legislation in WA passed in June of 2014 o ESHB 2746 o SSB 6387 CFC workgroup met between April & October of 2014 to design the benefit model 4

CFC supports our Strategic Plan A richer benefit provides needed supports to remain in the community Relocation out of institutional care is supported Supports client choice, flexibility, and independence CFC helps build a sustainable future by providing services that leverage federal funds while allowing clients to manage their own care needs 5 HISTORY– Why CFC?

Start date is 07/01/2015 CFC is a state-plan service – This means it is available in the benefit package of most regular Apple Health medicaid programs Must meet Institutional level of care – This means you must be assessed and meet the functional requirements of the program. 6 GENERAL REQUIREMENTS

CURRENT 7 OUR CURRENT SYSTEM Institutional Home & Community Based Entitlements (State Plan) Waivers (Other Medicaid) Home & Community Based Medicaid Personal Care Personal Care Waiver Svcs Personal care PERS Equipment Assistive Tech Home Mods Respite Therapies Habilitation Employment Support Other Nursing Facilities or ICF/ID Current: Client is eligible for one or the other

FUTURE 8 CFC IN OUR FUTURE SYSTEM Entitlements (State Plan) Institutional Home & Community Based MPC or Community First Choice Required Services Personal Care PERS Systems Skills Acquisition Training Caregiver Management Training Optional Services Community Transitions Assistive Technology Waivers Ancillary Services Wrap-Around to CFC Services Nursing Facilities or ICF/ID New: Clients may be on both programs! Waivers (Other Medicaid)

9 Program Options New Program Option Choices: – MPC MPC services will not change, but functional eligibility will change – CFC New State Plan service Primary program for most clients The main source for personal care for most clients – CFC + Waiver (COPES) Clients may be on both CFC and a waiver This is new for HCS

10 State Plan Eligibility Medicaid Personal Care – Client does not meet institutional level of care – Client is eligible for a CN medicaid program (excluding waiver programs) Community First Choice Only – Client meets institutional level of care – Client is eligible for a CN medicaid programs (including waiver programs)

11 Waiver Eligibility Community First Choice + Waiver Services – Must be functionally & financially eligible for waiver A new application may be required (HCA form) – Clients must meet age (65+) or disability requirements to access waiver services. – Why would someone need or want a waiver? They require a service not available in CFC They have an income over standard for a non- institutional medicaid program. To continue waiver eligibility, client must receive a waiver service every month

12 What services are included in CFC? Monthly Services o Personal Care  In-home with IP, Agency, or Relief care providers  Residential Care – AFH or ALF o Skills Acquisition Training  May use in-home care hours for this service o PERS Systems  Client must meet WAC criteria

13 Limited Annual Services o $500 per fiscal year per client  Fiscal year is July 1 – June 30 o Assistive Technology o Skills Acquisition Training Additional Services o Community Transition Services  $850 per occurrence  RCL continues to be the preferred program o Training on managing caregivers  On-line, booklets, DVDs What services are included in CFC?

14 Additional Services o Community Transition Services  $850 per occurrence  RCL continues to be the preferred program o Training on managing caregivers  On-line, booklets, DVDs What services are included in CFC?

15 In your own home with a paid caregiver In a residential setting: – Adult family home (AFH) – Adult residential center (ARC) – Assisted Living (AL)* – DDA group home –* Currently MPC services are only available in an ARC or AFH – CFC includes more settings. Where can I get CFC services?

How do I apply for CFC? – Recipients: No application required - just need to schedule an assessment through our intake process – Applicants: Must file an application - HCA form (just like today) – Can apply online at – (see handout) 16 FINANCIAL ELIGIBILITY

How am I eligible? – Must be eligible for Washington Apple Health categorically needy (CN) or alternative benefit plan (ABP) scope of care – This includes clients who access CN coverage through an HCS or DDA waiver. Not eligible for CFC: – Medically needy (MN) – Alien emergency medical (AEM) 17 FINANCIAL ELIGIBILITY

If I’m already eligible for non-institutional medicaid: – No transfer of asset rules apply – No post eligibility treatment of income (PETI) If I need to apply for COPES: – Transfer of asset rules DO apply – Must pay towards cost of services for both CFC and waiver services. 18 FINANCIAL ELIGIBILITY

Cannot have a home with equity above the limit ($552,000) Must still pay Room & board (rent) in residential settings (for example an adult family home or assisted living). 19 FINANCIAL ELIGIBILITY

Income and Asset limits – Income: the limit for each specific program applies – Resources: Non-institutional SSI-related medicaid: – Single $2000 – Married couple $3000 Institutional SSI-related medicaid: – Single $2000 – Marred couple $53,016 (+ the $2000) BUT……….. 20 FINANCIAL ELIGIBILITY

Spousal Impoverishment (SI) and CFC – SI protects the income and assets of a community spouse – A community spouse is the husband or wife of someone received long-term services & supports – Historically SI only applies to people in a nursing facility or receiving waiver services – In the CFC world, SI applies to a married person is is found functionally eligible for CFC 21 FINANCIAL ELIGIBILITY

Spousal Impoverishment (SI) and CFC – What does this mean? Current ‘Classic’ medicaid rules require a couple to spend down resources to $3000 or less With CFC, the applicant can now have $2000 and the spouse can have the higher resource limit of $53,016 Current ‘Classic’ medicaid rules require we count both persons income in the eligibility determination With CFC, we only count the applicant’s income using name on check rules. 22 FINANCIAL ELIGIBILITY

To sum up: CFC becomes the state’s priority program to deliver long-term services & supports Most services in the HCS waivers will be moved to CFC You can receive CFC by itself; or You can receive BOTH a waiver and CFC for example: – Wellness Education through the waiver – Personal Care through CFC 23 PUTTING IT ALL TOGETHER

If you are eligible to receive medicaid coverage today, you have met the eligibility criteria for CFC – you just need to have care needs that meet the functional criteria If you are not eligible for a regular medicaid program due to income or resource rules, you may get another chance using spousal impoverishment rules 24 PUTTING IT ALL TOGETHER

Transfer penalties do not apply to non- institutional Apple Health programs so would not apply to CFC If your income is too high and you can only access CFC by using institutional waiver eligibility, transfer penalties do apply CFC provides a greater choice of settings and person-centered care plans. 25 PUTTING IT ALL TOGETHER

26 HCS & AAA Contact: Tracey Rollins, HCS (360) DDA Contact: Jaime Bond, DDA (360) Financial Services Contact: Rob Peters, Financial Services (360) Web Site: ommunity-first-choice-option Or Go to Choose: “Stakeholders” Choose Community First Choice Program Management Team

27 QUESTIONS?