HR1 Federal Change: What This Means for AFHs
Due to a new federal law, House Resolution 1 (HR1), the federal government is adding new restrictions on who can receive certain benefits that rely on federal funding. This includes Apple Health Medicaid long-term services and supports (LTSS). Beginning October 1, 2026, some adult immigrant residents in adult family homes will lose their federally funded Apple Health LTSS because of their immigration status.
This change will impact residents who are currently receiving federal Medicaid LTSS and whose status is in one of the following categories:
Refugee
Asylee
Victim of trafficking
Ukrainian humanitarian parolee
Other forms of humanitarian protection
Starting in July 2026, residents in these groups will receive informational letters explaining the upcoming changes and advising them to report any changes in their immigration or citizenship status to DSHS. These letters are meant to help people understand what is happening and what, if anything, has changed in their status.
What this could mean in your home
For adult family homes that serve residents in these categories, this means that if a resident loses federally funded LTSS as of October 1, 2026, you will see changes in how, or whether, your home is paid for that resident’s care.
The Legislature did allocate some state funding to help soften the impact, and the state is working on a new limited state-funded program for a certain number of people who are losing federal coverage. However, there are more affected residents than there is state funding. That means not everyone who loses federally funded LTSS will be able to move to this new state program, and some providers may find themselves caring for residents whose funding is reduced or not available.
What’s coming next
Here’s the general timeline DSHS has described:
July 2026: Residents begin receiving informational letters about HR1 changes.
August–September 2026: Case managers and headquarters staff work on assessments, notices, and identifying who might transition to other options (such as Medical Care Services or the new limited state-funded program).
October 1, 2026: HR1 changes take effect for LTSS, and some residents will be disenrolled from federally funded Apple Health LTSS.
During this time, you may see more communication from DSHS and case managers, and residents or families may come to you with questions after they receive their letters.
What AFHs can do right now
Here are a few concrete steps you can take:
Identify potentially impacted residents. If you serve residents with refugee, asylee, trafficking survivor, Ukrainian humanitarian parolee, or other humanitarian statuses, be aware they may be affected by HR1.
Watch for notices and updates. Keep an eye out for letters or emails from DSHS and for communication from case managers regarding these residents.
Track impacts in your home. If you start to see changes in funding, admissions, or discharge planning tied to HR1, document those impacts. This information is helpful both for your own planning and for AFHC’s advocacy and bargaining work.
Stay connected with AFHC. We will continue to share updates as more details become available about the new limited state-funded program and who will be eligible to transition into it.
AFH Council Next Steps:
AFHC has already submitted a formal demand to bargain regarding the impacts of this proposal on adult family home providers. This article is primarily to raise your awareness and help you think about your next steps. We know this will not apply to every home or every resident, but for those who are affected, the impacts could be significant. As negotiations and rulemaking move forward, we will keep you updated and share more specific guidance as soon as we have it.
Not a Member Yet?
Membership fees enable the Council to cover legal expenses and fund staff to advocate with the state and regulatory agencies. The participation of every adult family home is vital to ensuring fair regulations and rates that accurately reflect the costs of caring for our vulnerable adults. Consider becoming a member of the Council to help us continue improving conditions for all adult family homes in Washington State.