Washington calls its Medicaid program Apple Health, but the operational reality of home care involves two separate state agencies with two separate roles — and a single system, ProviderOne, that handles both billing and EVV aggregation. HCA writes the rules and pays the claims. DSHS/ALTSA assesses clients and authorizes services. If you only know one side of that, you'll spend your first year confused about why your claims are clean but your authorizations aren't moving. Here's the full picture.
The single most important thing to understand before operating in Washington home care is that two state agencies govern different parts of your work — and they don't always communicate as smoothly as you'd hope. Your enrollment and claims are with HCA through ProviderOne. Your service authorizations and care coordination for COPES and other LTSS programs are with DSHS/ALTSA through local offices. You need both relationships working correctly for any client to be served and paid.
The practical consequence: enroll with HCA through ProviderOne first. Then establish your relationship with DSHS/ALTSA through the local HCS office and regional AAA covering your service area. Both relationships are required before you can serve a COPES client. HCA enrollment alone doesn't give you access to DSHS/ALTSA waiver referrals. DSHS/ALTSA relationships alone don't enable billing.
COPES (Community Options Program Entry System) is Washington's primary 1915(c) HCBS waiver — personal care, homemaker, adult day health, respite, and other community services for adults who need NF level of care but choose to remain home. Administered by DSHS/ALTSA.
COPES may have a waiting list depending on available enrollment slots and current program capacity — unlike Virginia's CCC Plus, COPES is not guaranteed as a no-waitlist entitlement. HCS case managers conduct the in-home functional assessment using Washington's assessment tool. Once authorized, service plans are managed by the case manager through the DSHS local office.
Billing goes to ProviderOne for FFS COPES members. Members enrolled in Apple Health managed care plans bill the MCO — verify enrollment before billing.
Washington's Medicaid Personal Care (MPC) is a state plan benefit covering personal care assistance for Apple Health members who need help with activities of daily living but may not meet NF level of care. MPC is broader in eligibility than COPES but covers a narrower range of services.
Like COPES, MPC is coordinated through DSHS/ALTSA with in-home assessments determining authorized hours. Some MPC clients are also enrolled in managed care — verify enrollment status before billing ProviderOne directly.
Washington's Community First Choice (CFC) is a state plan option under Section 1915(k) providing attendant care services and supports to individuals who need NF level of care. CFC operates alongside COPES as another pathway for personal care services.
CFC supports both agency-directed and consumer-directed service delivery. DSHS/ALTSA coordinates CFC through the same HCS case management structure as COPES. Billing through ProviderOne for FFS members.
Washington's consumer-directed care model uses CDWA (Consumer Direct Care Network Washington) as the statewide Consumer Directed Employer (CDE) for all Individual Providers, effective June 1, 2022. Medicaid clients who choose consumer-directed services work with CDWA — not with a traditional home care agency — to hire and manage their Individual Provider.
Individual Providers employed by CDWA use the CareAttend app for EVV and scheduling. Home care agency employees are entirely separate from IPs. Live-in Individual Providers are exempt from EVV — agency-employed caregivers are not.
Washington's ProviderOne system is unusual in the national Medicaid landscape: it serves as both the claims submission and payment system (administered by HCA) and the EVV data aggregator (for DSHS/ALTSA programs). Claims for personal care, respite, and home health services submitted by home care agencies must include the required EVV data elements within the claim file — the EVV data and the claim travel together into ProviderOne.
Washington uses a Provider Choice (open) EVV model — agencies may use any compliant EVV system that captures the six required data elements and submits them to ProviderOne in the required file format. Washington will not mandate a specific EVV system. DSHS/ALTSA's EVV team provides file layout specifications and submission guidance. Contact: [email protected]. For home health (acute care) EVV questions: [email protected].
| Program/Scenario | Where Claims Go | EVV Requirement | Key Note |
|---|---|---|---|
| COPES / MPC / CFC (FFS member) | ProviderOne (HCA) | Required — submitted with claim file | EVV data elements included in ProviderOne submission. Open model — use your own compliant system. |
| Apple Health Managed Care member | Member's MCO directly | MCO-specific EVV requirements | Check eligibility and MCO enrollment through ProviderOne before billing. Most Apple Health members are in managed care. |
| Consumer-directed (Individual Provider) | CDWA manages IP payroll; HCA pays CDWA | CareAttend app (CDWA-managed) | Agencies are not in the IP/CDWA payment chain. CDWA handles all IP employment and EVV functions. |
| Live-in caregivers (IPs only) | Standard CDWA pathway | Exempt — live-in IPs do not use EVV | EVV exemption applies only to Individual Providers who reside with their client. Does NOT apply to agency-employed caregivers. |
Effective January 1, 2026, the Washington Apple Health institutional provider enrollment application fee increased to $750, up from $730 in 2025. This fee applies to new enrollments, changes of ownership, reactivations, and new service locations. Providers already enrolled with Medicare or Apple Health are exempt.
The fee is set by CMS annually under 42 CFR 455.460. Contact HCA Provider Enrollment at 1-800-562-3022 ext. 16137 (open Tuesdays and Thursdays 7:30am–4:30pm) for enrollment questions.
ProviderOne enrollment gives you the right to bill Apple Health fee-for-service. Most Apple Health members are in managed care. Serving managed care members requires separate credentialing with each MCO operating in your service area.
HCA enrollment and MCO credentialing run on independent timelines. Completing ProviderOne enrollment does not trigger MCO credentialing. You could be fully enrolled with HCA and unable to serve the majority of Apple Health members in your area if MCO credentialing is not also complete. Contact each Apple Health MCO operating in your counties directly to initiate credentialing.
Revalidation is required every five years for Washington Apple Health providers. DSHS/ALTSA also requires providers to keep their license, certification, and background check records current independently of HCA enrollment. Workers must be rostered in ProviderOne through the bulk enrollment roster upload process — DSHS/ALTSA's EVV team provides the roster file format. Workers not correctly rostered in ProviderOne cannot have their visits matched for EVV compliance.
Not yet — ProviderOne enrollment with HCA is necessary but not sufficient for COPES. Service authorizations for COPES come from DSHS/ALTSA case managers, not HCA. You need to establish your agency relationship with the local DSHS HCS office and the AAA covering your service area. DSHS/ALTSA case managers refer COPES clients to contracted home care agencies — if they don't know your agency exists and have it in their referral network, you won't receive COPES clients regardless of your HCA enrollment status. Reach out to your local DSHS HCS office and regional AAA as soon as your HCA enrollment is confirmed.
CDWA (Consumer Direct Care Network Washington) is the statewide Consumer Directed Employer that manages all Individual Providers — care workers hired directly by Medicaid clients in Washington's consumer-directed model. CDWA is not a competitor to home care agencies; it operates an entirely separate employment track. Home care agency employees and Individual Providers employed by CDWA are parallel systems. Your agency doesn't work with CDWA — you work with HCA and DSHS/ALTSA for your agency-employed caregiver clients, while CDWA independently manages IP employment for clients who chose consumer-directed care.
No. Washington uses a Provider Choice (open) EVV model. You may use any EVV system that captures the six required data elements and submits them to ProviderOne in the required file format. Washington will not mandate or recommend a specific system. The key requirement is that your EVV data submits correctly to ProviderOne — DSHS/ALTSA's EVV team provides the technical specifications. Contact [email protected] for file format requirements and submission guidance.
Yes. Most Apple Health (Medicaid) members in Washington are enrolled in managed care plans rather than fee-for-service. For managed care members, claims go to the member's MCO rather than ProviderOne directly. Apple Health managed care plans include Coordinated Care, Molina Healthcare of Washington, Community Health Plan of Washington, and others depending on region. Each plan has its own credentialing requirements and timelines. Check current plan participation in your counties through the HCA website — Apple Health managed care plan availability varies by county. ProviderOne enrollment is required as a prerequisite to MCO credentialing, but the two processes run on separate tracks.
Agencies that understand both the HCA enrollment relationship and the DSHS/ALTSA referral relationship from the start operate more effectively than those who discover the distinction when claims process but clients don't arrive. The CareDrain Diagnostic shows what your current operational gaps are costing monthly — before you invest in building Washington market relationships.