Non-Citizen Residents in Adult Family Homes
The Department of Social and Health Services (DSHS) has started a new rulemaking process to create a state-funded long‑term care program for certain non‑citizen Washington residents. This will not change current Medicaid rules, but it could open a new pathway to services for people who do not qualify for federally funded long‑term services and supports (LTSS) because of their immigration status.
This means that some of the residents you may be caring for in your AFH would be paid out through this new state program. Right now, this is in the earliest stage (a CR‑101). That means DSHS is announcing what they plan to work on and asking for input before they write draft rules. No changes take effect yet, and there are no new billing or documentation requirements at this time
In other words:
DSHS wants to set up a limited benefit program for non‑citizens who do not meet the federal immigration criteria for Medicaid LTSS.
These individuals would still need an identified CARE classification showing they need long‑term care.
The program would be funded by the state and will only move forward as money is available in the state budget.
What this could mean for AFHs:
You may see a new group of potential residents who need AFH‑level care but have been shut out of Medicaid LTSS because of immigration rules.
Payment rules and benefit limits for this state program may look different from what you are used to under standard Medicaid.
DSHS is planning to spell out provider requirements and administrative standards as part of this process, which could include specific expectations for AFHs that choose to serve these clients.
Please share your experience with us if you currently serve non‑citizen residents or have had to turn people away because they could not qualify for Medicaid LTSS.
The Adult Family Home Council will monitor this rulemaking and share updates as DSHS moves from this early inquiry stage to draft rules that identify covered settings, program structure, and provider requirements
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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.