Washington AFH Rules Have Changed: Old Requirements vs. Today's Standards

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The home must notify DSHS and receive an approved inspection from DSHS before letting a resident sleep in a bedroom DSHS has not already inspected and approved.

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Partial evacuation drills at least every two months, on random staffing shifts.

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For homes licensed after September 20, 2026, every internal door residents pass through that is not an emergency exit must be at least 27 inches wide.

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DSHS "must" deny that license. The same filing repealed the rule that barred certain state employees and their household members from licensing.

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"Plan of correction (POC)—When required." It does not apply when DSHS summarily suspends or revokes the license.

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The record must include a copy of the notice of rights and services, and the resident's acknowledgement that they received it, signed and dated by the resident and the home.

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The Washington Supreme Court held that the exemption violates the state constitution as applied to live-in caregivers in adult family homes. Whether the ruling reaches back to earlier pay periods was sent back to the trial court.

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Qualifying former foster parents who care only for former foster youth they previously served, with no abuse findings or adverse licensing actions, are exempt.

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WAC 388-76-10231 now spells out the resident contact list and the 48-hour deadline after a long-term care ombuds's written request. WAC 388-76-10980 now says a stop placement order must be publicly posted where residents, visitors and staff can see it, and stay posted until DSHS ends it.

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Each resident with Medicaid as a payor signs a written residency agreement at admission that commits the home to the transfer and discharge rights in chapter 70.129 RCW and gives notice that, subject to legislative appropriation, residents have the right to legal counsel at public expense. Discharge notices must include legal-services and ombuds contacts. The required contact details were corrected April 30, 2026 (WSR 26-08-074).

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The home keeps a roster of residents and rooms and hands a copy immediately to ombuds or DSHS staff who ask in person. During a public health emergency that limits visits, residents must still have access to an essential support person.

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Certified within 365 days of hire, or 425 days with a provisional certificate, for applicants who apply by December 31, 2027. Training is still due within 120 days of hire.

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A medical foster home overseen and reviewed each year by the U.S. Department of Veterans Affairs, caring for three or fewer veterans, is exempt.

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A new agreement through June 30, 2027. The Health Care Authority's notice described a weighted-average increase of 14 percent in AFH daily rates. The two rate regions are unchanged: King, Pierce and Snohomish counties are paid more than the rest of the state.

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$450 per licensed bed per year for renewals on or after July 1, 2025 ($2,700 for six beds), per DSHS's written answer. The 2025–27 bargaining agreement adds $0.62 per Medicaid day to rates to offset the fee on Medicaid beds.

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The 2025–27 operating budget eliminated the adult family home Meaningful Day add-on.

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For assessments on or after July 1, 2025, a resident must first be found not eligible for Community Behavioral Health Support before receiving SBS or on-site staffing ratios under the residential support waiver.

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DSHS combined ALTSA with the community side of the Developmental Disabilities Administration into the Home and Community Living Administration (HCLA). Many web addresses still use /altsa/.

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The current form is DSHS 15-604, revised 04/2025. It does not yet show the 27-inch interior door rule, which is a DSHS licensing rule rather than a checklist item.

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A 7- or 8-bed home without an automatic sprinkler system may operate if it serves only residents who can evacuate without assistance; its license is limited accordingly. It must report to DSHS when any resident comes to need help evacuating, and its notice of services must say such residents will be discharged.

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Homes licensed after August 1, 2023 need one accessible toilet per five persons, without going through another person's room; DSHS's explanation of the change says a toilet in a resident's own bathroom counts. Toilets residents do not use need not meet the AFH building code but must be closed to residents.

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Community Behavioral Health Support (CBHS), a Medicaid benefit run by the Health Care Authority with DSHS, paid in six tiers by the staff time a resident needs.

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The rule requires 48 hours of instructional time from an approved community college, matching RCW 70.128.120. Courses as offered may still run longer.

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Repealed. The content is covered in the required administrator training.

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A home may ask the Residential Care Services director in writing for an exemption from a specific requirement. It must not affect any resident's health, safety, rights or quality of life. The decision is at the director's sole discretion and cannot be appealed.

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Every home must carry both commercial general liability and professional liability insurance, at least $500,000 per occurrence and $1,000,000 aggregate, before the first admission or within 10 working days of licensing, whichever comes first. A lapse must be reported to DSHS.

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The provider files an attestation instead of waiting for approval. The provider remains responsible for the home.

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A provider may apply for seven or eight after at least 24 months under the initial license (including at least 12 months licensed for six residents), two full inspections with no enforcement action, and proof of financial solvency. A buyer of a 7–8 bed home must already have been a licensed provider for at least 24 months.