Thursday, May 3, 2012

Community First Choice Regulations Published. Information Bulletin # 357 (5/2012) 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 apartments. 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’ 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 to see what the FMAP is now WITHOUT the additional six points.) That translates into a LOT of federal money! 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 disabilities. 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 month’s rent/utilities, basic kitchen/bedding needs). 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 individual.” 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 it! 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 funds. Steve Gold, The Disability Odyssey continues Back issues of other Information Bulletins are available online at with a searchable Archive at this site divided into different subjects. As of August, 2010, Information Bulletins will also be posted on my blog located at To contact Steve Gold directly, write to or call 215-627-7100. Ext 227.

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