Clarifying information

The department authorizes CFC for a person who meets both:

Institutional level of care based on the assessment by HCS or DDA case manager or HCS social worker; and

Financial eligibility for a CN or ABP Medicaid program, including receiving CN through a HCB waiver. A person may receive both CFC and HCB waiver services at the same time.

Which community settings are used for CFC?

CFC can be authorized in a:

Person's home; or

HCS or DDA contracted alternate living facilities (ALF) contracted for CFC services.

What is the resource limit for CFC?

The resource limit is based on the CN or ABP program rules that the client is receiving:

For people eligible under the MAGI-based programs through the Health Benefit Exchange there is no resource limit;

For people eligible under Apple Health for Workers with Disabilities (HWD) there is no resource limit;

For people eligible under SSI-related programs; The single person resource limit is $2,000 The married couple resource limit is $3,000 The married couple resource limit using spousal impoverishment is $2,000 for the recipient and $54,726 for the community spouse beginning July 1, 2015. See resource standards.

The resource standard is found on the Standards - LTC and LTSS page .

Do transfer penalties apply to CFC?

Transfer penalties do not apply to people who only receive CFC. Transfer penalties do apply to home and community based (HCB) waivers described in 182-515 WAC . If a person needs CFC in combination with HCB waiver services, transfer penalty rules described in WAC 182-513-1363 apply.

Does the home equity limit apply to CFC?

The home equity limit described in WAC 182-513-1350 applies to CFC because it is considered "long-term care" under the Social Security Act

How does the eligibility process work?

If the client is not eligible for MAGI we need to consider eligibility for a classic Medicaid program under one of the groups listed below.

Group Income Resources Notes CFC Eligibility Only (L52*) Group A 2-person CNIL (married plus deemed income) $3,000 (married living together) $2,000 (all other) Regular S02 rules Group B 1-person CNIL State CSRA With community Spouse (CS) Group C SIL and state rate plus $38.84 $2,000 Not income eligible in Group A, lives in a contracted ALF Group D SIL and state rate plus $38.84 state CSRA With CS, not resource eligible in Group C HCB Waiver plus CFC or HCB Waiver Eligibility (L22/L32* / L42*) Group 1 Otherwise eligible using Group A $2,000 (single) state CSRA with (CS) HCS and DDA Group 2 Not Group A, but < SIL $2,000 (single) state CSRA (with CS) HCS and DDA Group 3 Not Group 2, but < Effective MNIL $2,000 (single) state CSRA (with CS) HCS Only (no hospice only)

Coverage group Description L51 CFC SSI L52 CFC SSI-Related

If a client is disabled and under 65 with earnings and not eligible under group A or group B, check to see if HWD is a better option than group C or D or under HCB waiver rules. A person can receive CFC under the HWD program.

Do clients pay participation on CFC services?

Clients living at home and only receiving CFC will have no participation.

If a CFC eligible person lives in an ALF:

And is eligible under Group A or Group B, this person keeps their personal needs allowance (PNA) and pays up to the Room and Board standard.

And is eligible under Group C or Group D, the person keeps their PNA, pays Room and Board, and pays the remainder of their income to their provider. This total amount is called "total client responsibility"

Clients receiving CFC and waiver pay participation for both CFC and waiver services depending on setting and which administration approves the services (DDA/HCS).

Which programs are not eligible for CFC?

Title XXI Children's Health Insurance Program (CHIP) because it is not a Title XIX Apple Health program.

State-funded children

Alien emergency medical (AEM)

Medical care services (MCS)

Program of all-inclusive care for the elderly (PACE)

New freedom

Roads to community living (RCL)

Medically needy (MN)

Does spousal impoverishment apply to CFC?

If otherwise eligible under group A, group C or Health Care for Workers with Disabilities (HWD), there is no need for spousal impoverishment protections. However, if not eligible under group A or group C due to spousal deeming or resources; or if not eligible under HWD due to spousal income, we can use spousal impoverishment protections.

If an SSI-related married person is found functionally eligible for CFC, and their spouse isn’t in a medical institution, the CFC eligible person can use the financial benefits of spousal impoverishment protections in eligibility. Spousal impoverishment applies to SSI-related noninstitutional Medicaid when there is a SIPC spouse. Even using spousal impoverishment, the client applying for CFC must meet the following:

Countable income in the name of the CFC eligible person must be at or below the standard for group B, group D, or HWD; and

Combined resources must be at or below the state resource standard, plus $2,000 (Resources do not apply to HWD).

When we apply spousal impoverishment to CFC does it work the same as spousal impoverishment for HCB waiver?

Yes. When a client is on CFC only and is married, spousal impoverishment rules, described in WAC 182-513-1220 (for CFC), apply just like WAC 182-513-1350 , WAC 182-515-1509 , and WAC 182-515-1514 (for waiver). However, since a CFC only person doesn’t participate, post eligibility protections do not apply.

Even though spousal impoverishment rules apply to the G03 program, there is no post eligibility spousal or dependent allocation, because there is no "participation" under the G03 program. Clients must still pay room and board and their remaining income towards total client responsibility.

Spousal impoverishment doesn't apply to modified adjusted gross income (MAGI) clients.

Can a client receive both CFC and waiver services? What about hospice?

Yes. Clients can receive CFC, waiver and hospice at the same time. Waiver will be the priority program, CFC and hospice will be services. The programs will all be identified on the INST screen in ACES mainframe or Institutional Care in ACES 3G.

Are full benefit dual eligible (FBDE) recipients who receive CFC-only exempt from Medicare Part D copayments in the same way as HCB waiver recipients?

No. Under the Low Income Subsidy (LIS) Program, dual eligible clients who receive CFC-only will not be LIS 3 (like HCB waiver and institutional clients), and are subject to Medicare Part D copayments.

If a client has high Medicare Part D costs, financial staff should coordinate with social services to move the client to a HCB waiver if possible.

What if someone on CFC needs a service only available under a waiver?

If a client is on CFC only, and needs a waiver service, financial staff will receive a communication from either the HCS social worker 14-443 or DDA case manager 15-345 informing of the change. The client will remain on the waiver until their next annual assessment or significant change.