Washington Adult Family Homes: Rules & Key Figures
The rules and numbers that matter for an adult family home in Washington, each with its source. Tap a question for the explanation.
Counted from the DSHS Adult Family Home Locator, retrieved September 14, 2026. See the full data
Washington adult family homes at a glance
| Topic | The rule | Source |
|---|---|---|
| Who licenses it | DSHS Residential Care Services licenses the provider and inspects the home. | Ch. 388-76 WAC |
| How many residents | Two to six adults not related to the provider. DSHS may approve seven or eight for an experienced provider. | RCW 70.128.010 |
| Who lives there | The provider, entity representative or a resident manager, unless the home has 24-hour staffing with a decision-maker always present. | WAC 388-76-10040 |
| Zoning | A permitted use in every residential or commercial zone, including single-family zones. | RCW 70.128.140 |
| Owner experience | 1,000 hours of direct care in the last 60 months (licensed physicians, PAs and nurses exempt); new applicants also complete AFH Administrator Training. | WAC 388-76-10130 |
| Caregiver training | 75 hours and a Home Care Aide certification for most caregivers, then 12 hours of continuing education a year. | Ch. 388-112A WAC |
| The building | Passed by the local city or county building official, using DSHS form 15-604, before the home can be licensed. | WAC 388-76-10700 |
| Annual license fee | $450 per licensed bed since July 2025 ($2,700 for six beds), per DSHS in writing. | WAC 388-76-10025 |
| Routine inspections | At least every 18 months, 15 on average, and unannounced at any time; up to two years after three citation-free inspections. | RCW 70.128.070 |
| When the home is sold | The license does not transfer. The buyer applies for a new one; the seller gives DSHS and residents 60 days' written notice. | WAC 388-76-10105 |
Checked against each rule on September 29, 2026. The license fee is from DSHS's written answer of the same date; the rule itself says the fee is set in the state budget. What changed recently, and when: Washington AFH Rules Have Changed.
Key questions
Does the license transfer when an adult family home is sold?
No. Washington treats any change in the provider, or in who controls the provider, as a change of ownership, and a change of ownership "requires both a new license application and a new license" (WAC 388-76-10105). That includes forming an LLC around an existing home or transferring half or more of an entity's shares.
The current owner gives DSHS and each resident written notice 60 calendar days before the proposed change (WAC 388-76-10106). The buyer (for an entity, its entity representative) must meet every provider qualification. DSHS confirmed in writing that a continuously licensed home keeps the building rules it was first licensed under, so the new 27-inch door rule does not apply to it; a home whose license lapsed must meet current rules. ECS and SBS contracts do not transfer.
How long does licensing take?
DSHS does not promise a timeline. It posts its application queue instead: in late September 2026 it was working on applications received in May 2026, and it allows up to 60 days once an application is complete (DSHS processing timeline). The local building inspection must be passed before the home can be licensed. DSHS told AFH Club in writing that once it approves a license, it emails the license letter and license to the new provider within a day.
How do adult family homes get paid?
Mostly through Medicaid. A DSHS case manager's CARE assessment places each Medicaid resident in one of 17 classifications, from A Low to E High (WAC 388-106-0115). The classification and the rate region set the daily rate DSHS pays: homes in King, Pierce and Snohomish counties are paid more than homes in the rest of the state (DSHS rates).
On top of that, a resident may qualify for Community Behavioral Health Support (CBHS), paid in six tiers by the staff time the resident needs. Some homes hold owner-level ECS or SBS contracts for residents with complex behavioral needs. Private-pay rates are set by each home; no agency publishes them.
What does the house itself need?
The local city or county building official inspects the house against DSHS form 15-604, the Adult Family Home Local Building Inspection Checklist, before the home can be licensed (WAC 388-76-10700). It covers bedroom exits and classifications, emergency escape windows, smoke and carbon monoxide alarms, doors, ramps, stairs, bathrooms and fire access. WABO helped write the checklist but does not inspect. Homes licensed after September 20, 2026 also need interior doors at least 27 inches wide wherever residents pass through, and since that date no resident may sleep in a bedroom DSHS has not inspected and approved.
How often are homes inspected, and where is the record?
DSHS inspects every licensed home at least every 18 months, with an annual average of 15, and may inspect unannounced at any time. A home with no citations on its last three inspections, and no complaint violations in that period, may go two years (RCW 70.128.070). Enforcement ranges from license conditions and civil fines to stop placement, suspension and revocation (RCW 70.128.160).
The DSHS Adult Family Home Locator shows each home's license and the limits and enforcement letters issued in the previous three years.
What training does an owner need?
A provider, entity representative or resident manager needs 1,000 hours of direct care to vulnerable adults within the previous 60 months (licensed physicians, physician assistants and nurses are exempt). A new license applicant, or an entity's representative, also completes AFH Administrator Training of at least 48 hours. All three need specialty training before serving residents with dementia, mental illness or developmental disabilities. Most caregivers complete 75 hours of training and a Home Care Aide certification, then 12 hours of continuing education a year.
Terms to know
- CHOW (Change of ownership)
- Any change in the provider or in control of the provider: selling the business, forming or merging an entity, or transferring 50 percent or more of an entity's shares. It requires a new license application and a new license; the seller's license does not transfer.
- CARE assessment
- The DSHS case manager's assessment of a Medicaid client's cognition, clinical complexity, mood and behavior, daily living needs and exceptional care. It places the resident in one of 17 residential classifications.
- A through E classifications
- The five CARE groups, split into 17 classifications from A Low to E High. With the rate region, the classification sets the Medicaid daily rate. They are groups, not a ladder: E is exceptional care, D and C are clinically complex (D with significant cognitive impairment), B is mood and behavior, A is everyone else.
- CBHS (Community Behavioral Health Support)
- A Medicaid benefit, run by the Health Care Authority with DSHS since July 1, 2024, that pays for supportive supervision of residents with qualifying behavioral health needs, on top of the base rate.
- ECS (Expanded Community Services)
- A specialty DSHS contract held by the owner for residents with complex behavioral needs. The home is paid the ECS daily rate or the resident's base rate, whichever is greater. It does not transfer when the home is sold.
- SBS (Specialized Behavior Support)
- A specialty DSHS contract held by the owner that pays a daily add-on on top of the base rate for six to eight extra hours of staffing a day. For assessments on or after July 1, 2025, a resident must first be found not eligible for CBHS. It does not transfer when the home is sold.
- Local building inspection (the "WABO inspection")
- The city or county building official's inspection of the house against the Adult Family Home Local Building Inspection Checklist (DSHS form 15-604). It must be passed before the home can be licensed, and it is separate from the DSHS licensing inspection.
- 27-inch interior door rule
- Homes licensed after September 20, 2026 need interior doors at least 27 inches wide wherever residents pass through (other than the emergency exit). DSHS confirmed in writing that a continuously licensed home sold through a change of ownership is exempt; a former AFH whose license lapsed is not.
Recently reviewed against their sources
- Do Adult Family Homes Pay Taxes?Reviewed October 13, 2026
- Getting Paid: ProviderOne Billing and Specialty ContractsReviewed October 12, 2026
- Leasing a House to an AFH OperatorReviewed October 12, 2026
- The AFH Payment Field GuideReviewed October 12, 2026
- Selling Your AFH Business at RetirementReviewed October 5, 2026
- Before You Buy an AFH: What to VerifyReviewed October 3, 2026
- AFH Costs & FeesReviewed September 29, 2026
- AFH GlossaryReviewed September 29, 2026
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