NYAPRS Note: New York State officials have already committed to adoptingthe CFC program, which will also apply to those at risk for residing in
what’s called an IMD (institute for mental disease) that includes
facilities over 16 beds.
Community First Choice Regulations Published.
Steve Gold May 2012 Information Bulletin # 357
Let’s hear the trumpets and the Halleluiahs chorus.
Finally, the Department of Health and Human Services/Centers for
Medicare & Medicaid Services issued the final regulations for the
Community First Choice option. The regulations state that CFC’s scope
is designed to make available home and community-based attendant
services and supports to eligible individuals, as needed, to assist in
accomplishing activities of daily living, instrumental activities of
daily living, and health-related tasks through hands-on assistance,
supervision, or cueing.
CMS listed CFC’s Total Benefits as providing States with additional
flexibility to finance home and community-based services and attendant
services and supports. The regulations state that CFC will increase
State and local accessibility to services that augment the quality of
life for individuals through a person-centered plan of services and
various quality assurances. CMS further noted that CFC reduces the
financial strain on States and Medicaid participants.
CFC is a win-win for States to save money and for people who need
community-based and attendant services to stay in their homes and
For many years, the Community First Choice was strongly supported and
initiated by ADAPT, a national grass roots organization of people with
disabilities of all ages and all disabilities. ADAPT organized large
numbers of supporters, testified before Congressional committees, and
last week demonstrated in front of HHS’s Washington offices demanding
CMS release CFC’s regulations.
Now that the federal regulations have been released, the struggle shifts
to you disability and aging advocates in each State – to make sure this
program is implemented in your State. Nothing happens automatically.
Unless advocates demand CFC state-by-state, it will not happen. Yes,
another local effort but quire worth the effort.
Here’s why your State should amend its Medicaid Plan to include the CFC
the federal government will pay an additional 6 percentages to your
State’s Federal Medical Assistance percentages. (Go to
http://aspe.hhs.gov/health/fmap.htm to see what the FMAP is now WITHOUT
the additional six points.) That translates into a LOT of federal
Another reason: yes, your State can save a lot of State funds while at
the same time complying with the ADA/Olmstead requirements to prevent
unnecessary isolation and institutionalization of people with
Here’s a brief summary of the final regulations:
1. CFC provides home and community-based attendant care services and
supports to persons with disabilities.
2. Such services must assist the individual with activities of daily
living, instrumental activities of daily living (e.g., shopping
cleaning) and health-related tasks.
3. States can provide, at the State’s option, transition costs (rent
and utility deposits, first months rent/utilities, basic kitchen/bedding
4. Individual eligibility requires that the person with a disability
meets your State’s institutional level of care criteria. The person
need not be in the institution nor packing their bags or at risk of
being imminently institutionalized. If the person meets the level of
care for the institution, the CFC services can be provided.
5. Individual financial eligibility is the same as what your State
has established for the institution.
6. Under the CFC, States must use a person-centered service plan and
the services must be self-directed, either with a self-directed service
budget or an agency-provider model.
7. This plan must be in writing and agreed to by the individual and
must be based on a functional needs assessment. The regulations state
that the person-centered service plan must reflect the services and
supports that are important for the individual to meet the needs
identified through an assessment of functional need.
8. These plans must be reviewed, and revised upon reassessment of
functional needs, at least every 12 months, when the individual’s
circumstances or needs change significantly, and at the request of the
What advocates must do:
1. Your State Medicaid Plan must be amended to include the CFC.
Advocates should be at the table to ensure the services meet your needs.
2. You need a statewide, multi-disability coalition and strategy to
ensure your State amends its Medicaid plan to include the CFC. If your
State does not already have such a coalition, the CFC presents an
opportunity to develop one. If your State has such a coalition, convene
3. You need to show your Governor why s/he should amend your State’s
Medicaid plan to provide CFC services. This will require real live
people who want and need CFC services. They must be ready to speak out.
CFC is a critical opportunity to end waiting lists.
4. You should get to your media and explain how this program will
save your State money, while bringing into your State additional Federal
Steve Gold, The Disability Odyssey continues
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