Washington · state plan
Community First Choice (CFC) in Washington
Community First Choice is Washington's main Apple Health (Medicaid) program for in-home personal care for people who need a nursing-home level of care. DSHS assesses how many hours of help the person needs, and a family member can be hired as an Individual Provider to do that care. The family caregiver is employed and paid by Consumer Direct Care Network Washington (CDWA), not by the family.
Also called: CFC · Community First Choice Option · CFC Washington · Apple Health personal care · CFC+COPES
Who do you care for?
Quick facts
- Pay
- $22.52–$27.28/hr
- Adult children & other relatives
- Yes
- Spouse
- Not right now
- Parent of a minor child
- Not right now
- Waitlist
- none
Who qualifies for CFC
- Eligible for Apple Health (Medicaid) under the Categorically Needy (CN) or Alternative Benefit Plan (ABP) scope of care in the community.
- Age 18 or older for services through Home and Community Services (HCS) or an Area Agency on Aging; people of any age with a DDA-determined developmental disability can be served through DDA.
- Meets nursing facility level of care (or ICF/IID level of care), or would likely need an institutional level of care within 30 days without services, as measured by a CARE assessment.
- Lives in their own home, an adult family home, assisted living, or another approved community setting.
Who can be paid as the caregiver
- Adult children & other relatives Yes
- adult children, siblings, grandchildren and other relatives can be hired as Individual Providers through CDWA once they pass the background check and training.
- Spouse Not right now
- DSHS says spouses cannot be paid to care for each other under Apple Health long-term services; Veteran Directed Care and the WA Cares Fund are separate routes that can pay a spouse.
- Parent of a minor child Not right now
- DSHS rules do not allow a natural, step or adoptive parent to be paid to care for their child under 18; parents can be paid once the child is an adult.
- Living together
- the caregiver may live with the client or live elsewhere.
Who employs the caregiver: Either. The client can pick an Individual Provider, who is hired and employed by CDWA (the Consumer Directed Employer) while the client chooses, schedules, supervises and can dismiss them. Or the client can use a licensed home care agency instead.
Spouse rules differ by program — see spouse pay in Washington.
How much CFC pays
$22.52–$27.28/hr. Individual Providers are paid by CDWA on the SEIU 775 contract wage scale, stepped by cumulative career hours: $22.52–$26.09/hr from July 1, 2025, rising to $23.54–$27.28/hr on July 1, 2026, plus union health, retirement and paid-time-off benefits. Pay is taxable wages.
Hours and budget: A DSHS or Area Agency on Aging case manager does a CARE assessment. CARE places the person in a classification group that sets the monthly personal care hours. The client can split those hours between more than one Individual Provider. Each Individual Provider also has a work week limit — 40 hours for most caregivers who started after January 2016, and never more than 65 hours.
Compare with other Washington programs on the Washington caregiver pay page, or across states in pay rates by state.
Is there a waitlist?
CFC is a Medicaid State Plan benefit, so everyone who qualifies can get it. (Some other DSHS programs, such as MAC and TSOA, started waitlists in December 2025; CFC is not one of them.)
How to apply for CFC
- The person needing care calls their regional Home and Community Services (HCS) intake line or applies for Apple Health long-term services online through Washington Connection.
- A case manager visits for a CARE assessment to check functional eligibility and set monthly hours; DSHS checks financial eligibility at the same time.
- The family member applies to become an Individual Provider with CDWA (consumerdirectwa.com), completes the background check, orientation and safety training, and is assigned to the client.
- The caregiver records hours through CDWA and finishes the rest of the required training (most paid family caregivers need 35 hours) within 120 days of hire.
- HCS Region 1 intake (Spokane / Eastern WA) · 800-459-0421 · official site
- HCS Region 2 intake (Seattle / Northwest WA) · 800-346-9257 · official site
- HCS Region 3 intake (Tacoma / Southwest WA) · 800-422-5129 · official site
- Consumer Direct Care Network Washington (CDWA) · 866-214-9899 · official site
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CFC questions
Can I get paid to take care of my mom or dad through CFC in Washington?
Yes. If your parent qualifies for CFC, you can be hired as their Individual Provider. You apply with CDWA, pass a background check and do the required training, and CDWA pays you for the hours DSHS approved.
Can a husband or wife be paid under CFC?
No. DSHS states that spouses cannot be paid to care for each other under Apple Health long-term services. DSHS points spouses to Veteran Directed Care (for qualifying veterans) or the WA Cares Fund instead.
What is the difference between CFC and COPES?
CFC is a State Plan program that pays for personal care and related supports. COPES is a separate waiver that adds services like adult day health. Many people are enrolled in both at once, shown as CFC+COPES in their care plan.
How many hours a month will CFC pay for?
It depends on the CARE assessment. CARE sorts the person into a classification group with a set number of monthly hours. Your own work week limit as a caregiver is usually 40 hours.
Is there a waiting list for CFC?
No. CFC is part of the Medicaid State Plan, so if the person qualifies financially and functionally, they can get services without a waitlist.
Who is my employer if I am a paid family caregiver?
CDWA is your legal employer and runs payroll, taxes and benefits. Your family member is the managing employer who decides your schedule and the tasks you do.
Sources: dshs.wa.gov · dshs.wa.gov · dshs.wa.gov · seiu775.org · dshs.wa.gov · Updated 2026-10-08. Program rules change — always confirm with the program.
Where most Washington caregivers are
Counties with the most residents aged 65 and older. The rules are the same everywhere in Washington — pick yours for the local picture.
Across the line
States that border Washington
Each state writes its own rules, and they differ more than people expect — a spouse who can be paid on one side of the line often cannot be on the other.