Community First Choice Washington — How to Get Personal Care Without a Waiver Waitlist

Why CFC Matters More Than Any Waiver

Washington's HCBS waiver system has a structural bottleneck: as of December 2024, over 20,231 DDA-eligible individuals sit on the No Paid Services caseload, approved for the program but receiving nothing. Waiver slots are capped by legislative funding, and waiting years for a Basic Plus or Core waiver enrollment is common.

Community First Choice sidesteps this entirely. CFC is a Medicaid State Plan entitlement under Section 1915(k) of the Social Security Act, which means anyone who meets the eligibility criteria has a legal right to services. There are no slots to fill, no waitlists to join, and no legislative cap on enrollment.

Who Qualifies

CFC has two requirements that must both be met:

Financial eligibility: You must be enrolled in Apple Health (Washington Medicaid). For SSI recipients, this is automatic — Washington is a Section 1634 state, so SSI approval triggers Apple Health enrollment through the automated data exchange. If you don't receive SSI, you can qualify through other Apple Health programs including Healthcare for Workers with Disabilities.

Functional eligibility: You must meet an institutional level of care — meaning your support needs are significant enough that without community-based services, you would require care in a nursing facility or Intermediate Care Facility. The CARE assessment conducted by a DDA Case Resource Manager determines whether you meet this threshold.

The functional standard trips up many families. It doesn't require that you're at immediate risk of institutionalization, just that your support needs reach that clinical threshold. Many people with moderate-to-significant daily living limitations qualify.

What CFC Provides

CFC covers a defined set of services that address personal care and daily living:

• Personal care assistance — help with eating, bathing, dressing, toileting, and mobility
• Assistive technology — devices and equipment that increase independence
• Personal emergency response systems (PERS) — emergency alert devices for people who live alone or spend time unsupervised
• Transition services — one-time costs to help someone move from an institution to a community setting

CFC doesn't cover residential habilitation, supported employment, or the broader menu of services available through the Core or Basic Plus waivers. Think of it as a focused personal care benefit that fills the gap while you wait for a waiver slot — or that serves as your primary support if your needs center on daily living assistance.

How to Request CFC

The process starts with your DDA Case Resource Manager. If you're on the No Paid Services caseload, you likely haven't had a CARE assessment recently — or at all. Here's the sequence:

1. Submit a Service and Information Request through the DSHS online portal or by contacting your regional DDA office. This formally puts your request on record.
2. DDA schedules a CARE assessment. The assessor evaluates your Activities of Daily Living using standardized functional criteria. For individuals aged 16 and older, the assessment incorporates the Supports Intensity Scale (SIS-A).
3. If you meet institutional level of care, CFC services can begin. Your Case Resource Manager develops a service plan specifying the type and hours of personal care authorized.

One critical preparation point: the CARE assessment evaluates what you can do without help — your "unaided performance." Parents naturally want to highlight their child's progress and capabilities, but describing the person at their best can result in a lower functional score and fewer authorized hours. Document what daily life actually looks like without parental prompting or physical assistance.

CFC vs. Waiver Services

Families often ask whether they should pursue CFC or hold out for a waiver. The answer is usually both. CFC doesn't block you from enrolling in a waiver later — you can receive CFC services while remaining on a waiver request list. When a waiver slot opens, you transition to the waiver's broader service menu.

The Washington SSI at 18 & Adult Disability Benefits Guide includes a complete CARE assessment preparation worksheet and a side-by-side comparison of every DDA service pathway, so you can build a strategy that starts with CFC and layers on waiver services as slots become available.

See more Washington guides →