Waiver Consulting Group — Start any program. In any state.

Washington - Transitional Assistance Services — Licensing, Medicaid Enrollment and Startup Requirements

Last reviewed: 2026-09-10

The Washington State Department of Social and Health Services (DSHS) administers Community Transition Services—formerly a 1915(c) waiver service but transitioned to the Medicaid State Plan under the Community First Choice (CFC) Option effective July 1, 2015, while remaining an authorized service on Developmental Disabilities Administration (DDA) waivers like the Core Waiver. Approval to deliver these non-recurring set-up expenses requires an applicant to already hold an active contract with DSHS as a residential habilitation provider or to secure a direct Medicaid contract through a regional Area Agency on Aging (AAA) before any enrollment application is accepted.

Providers do not obtain a distinct "Community Transition" license from the state; instead, they rely on their underlying facility or agency licensure (such as an Adult Family Home or Assisted Living Facility license) and their ProviderOne enrollment through the Washington State Health Care Authority (HCA). The approval sequence mandates executing a Core Provider Agreement with HCA and passing DSHS background checks before billing for security deposits, essential furnishings, and household supplies.

1. Service Definition and Scope

Community Transition Services fund non-recurring set-up expenses for Medicaid clients moving from an institutional setting or provider-operated living arrangement into a private residence where they are responsible for their own living expenses. The service covers essential household items and fees necessary to establish a basic domicile, explicitly excluding ongoing room and board costs.

The scope of allowable expenses is strictly limited to one-time costs that enable a person to establish a basic household.

2. Regulatory and Oversight Agencies

The Washington State Health Care Authority (HCA) serves as the Single State Medicaid Agency, managing the ProviderOne system and Core Provider Agreements. The Department of Social and Health Services (DSHS) operates the programs through its Aging and Long-Term Support Administration (ALTSA) and Developmental Disabilities Administration (DDA).

Local oversight and initial contracting for many home and community services are delegated to regional Area Agencies on Aging (AAAs).

3. Gatekeeping Prerequisites: Who Can Even Apply

Washington does not issue a standalone license for Community Transition Services, nor does it allow uncredentialed entities to enroll solely to provide this service. Applicants must meet structural preconditions tied to their existing provider status within the DSHS network.

While Washington allows for continuous open enrollment of all qualified providers without closed networks or moratoria, the prerequisite contracts act as the primary gate.

4. Licensure and Certification Requirements

Because Community Transition Services are administrative and financial in nature, the state does not have a specific "Transition Agency" license. Providers operate under their existing facility or agency credentials, such as an Adult Family Home (AFH) license or an Assisted Living Facility (ALF) license, depending on the client's living arrangement.

If the needed service is not one that is regulated by a specific license, the state ensures services are delivered as specified in the waiver participant's plan of care.

5. Medicaid Provider Enrollment

Providers must enroll through the Health Care Authority's ProviderOne system. Applicants who receive a Medicaid contract from DSHS or an AAA are mailed a ProviderOne Enrollment Packet from HCA.

All billing providers must complete and sign a Core Provider Agreement and other required documents with the agency.

6. Staffing, Training and Background Checks

Personnel coordinating transition services must clear state background checks and meet basic training standards tied to their underlying provider type.

Background checks are managed by DSHS and must be renewed on a strict cycle.

7. Documentation, Policies and Records

Providers must maintain documentation proving that transition funds were spent exclusively on allowable set-up expenses. Records must align with the participant's approved plan of care.

The state monitors against waiver requirements for all services delivered, utilizing principles of Continuous Quality Improvement.

8. Billing, Rates and Claims

Reimbursement for Community Transition Services is processed through ProviderOne. DSHS determines the Medicaid rates for Home and Community Services, which are published by the ALTSA Office of Rates Management.

Because these are non-recurring set-up expenses, billing is strictly capped at the authorized limit in the client's care plan.

9. Approval Sequence and Timeline

The approval process begins at the local or regional level before moving to the state Medicaid agency for final system enrollment.

Providers cannot initiate ProviderOne enrollment for this service until the underlying contract is secured.

10. Common Denials and Survey Findings

Applications and claims are frequently delayed or denied when providers fail to secure the prerequisite regional contracts or attempt to bill for unallowable ongoing expenses.

Auditors closely review receipts to ensure funds were not used for room and board.

11. Key Contacts and Resources

Prospective providers should utilize the official state portals and regional offices to initiate the contracting and enrollment process.

HCA and DSHS provide dedicated support lines and training materials for new contractors.

See all Washington services · Washington Medicaid consulting · book a consultation.