ADULT FAMILY HOME (AFH) PROVIDER IN WASHINGTON

Fatumata Kaba
2 hours ago
3 min read

DELIVERING PERSONALIZED, ROUND-THE-CLOCK CARE IN A RESIDENTIAL SETTING TO SUPPORT AGING ADULTS AND INDIVIDUALS WITH DISABILITIES

Adult Family Homes (AFHs) in Washington offer 24-hour care, supervision, and assistance with activities of daily living (ADLs) in a licensed home-based setting. Each AFH can serve up to six residents, allowing for an intimate, community-centered alternative to institutional care. AFHs are ideal for individuals who need support with personal care, medication management, and basic health-related services while maintaining independence and social engagement.

AFHs are licensed and regulated by the Department of Social and Health Services (DSHS) and may receive Medicaid reimbursement through Apple Health’s Long-Term Services and Supports (LTSS), including programs like COPES, Community First Choice (CFC), and Medicaid Alternative Care (MAC).

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1. GOVERNING AGENCIES

Agency: DSHS – Residential Care Services (RCS)

Role: Licenses and inspects Adult Family Homes, enforces compliance with WAC 388-76.

Agency: DSHS – Aging and Long-Term Support Administration (ALTSA)

Role: Manages Medicaid-funded care for older adults and people with disabilities in residential settings.

Agency: Health Care Authority (HCA)

Role: Administers Medicaid reimbursement for LTSS under Apple Health.

2. ADULT FAMILY HOME SERVICES OVERVIEW

AFHs provide a home-like setting with:

Personal care – Bathing, grooming, toileting, dressing
Medication administration and monitoring
Meal preparation – Including therapeutic diets
Laundry and housekeeping
Supervision and safety monitoring
Recreational and social activities
Support with transportation to appointments
Coordination with healthcare providers

Residents may include older adults, adults with physical disabilities, or adults with developmental/intellectual disabilities.

3. LICENSING & PROVIDER APPROVAL REQUIREMENTS

Prerequisites:

Be at least 21 years old and pass a DSHS background check
Complete the Adult Family Home Orientation Class
Identify a suitable home property that meets building and zoning requirements
Pass a home inspection by DSHS
Complete the 75-hour Adult Family Home Administrator Training
Submit an AFH license application through DSHS
Obtain liability insurance, business license, and register with ProviderOne

4. WASHINGTON PROVIDER ENROLLMENT PROCESS

Step 1: Complete orientation and review WAC 388-76 regulations

Step 2: Submit AFH license application and background check

Step 3: Complete AFH Administrator Training and required certifications

Step 4: Pass environmental inspection and safety compliance review

Step 5: Enroll in ProviderOne as a Medicaid LTSS provider

Step 6: Accept referrals from case managers and start services

5. REQUIRED DOCUMENTATION

AFH license issued by DSHS
Proof of orientation and training completion
ProviderOne Medicaid enrollment confirmation
Policy & Procedure Manual including:
- Resident admission and assessment process
- Fire safety, evacuation, and infection control policies
- Medication management and shift documentation logs
- Abuse prevention, incident reporting, and HIPAA compliance
- Menu plans, nutrition logs, and special diet documentation
- Staff schedules and continuing education logs
- Client rights and grievance forms

6. STAFFING REQUIREMENTS

Role: Adult Family Home Provider / Administrator

Requirements: Complete 75-hour training, be on-site or available 24/7, and provide hands-on care

Role: Caregivers / Staff

Requirements: Must complete caregiver certification, pass background checks, and receive ongoing training

Role: Nurse Consultant (if needed for RN-delegation tasks)

Requirements: Licensed RN available to supervise complex medical tasks

All staff must complete:

CPR/First Aid certification
Dementia and mental health training (if applicable)
Infection control and universal precautions
Abuse reporting and resident safety protocols
Annual continuing education (CE) hours per state guidelines

7. MEDICAID PROGRAMS THAT COVER AFH SERVICES

Services in AFHs may be reimbursed under:

COPES Waiver – For clients needing personal care in residential settings
Community First Choice (CFC) – Medicaid personal care program
Medicaid Alternative Care (MAC) – For unpaid caregivers supporting aging loved ones
Tailored Supports for Older Adults (TSOA) – For clients not yet eligible for Medicaid
DDA Core Waiver – For individuals with intellectual or developmental disabilities