Connecticut Community First Choice (CFC) is a state plan Medicaid option made possible with the launch of the Affordable Care Act (“ObamaCare”). Under CFC, elderly state residents can receive a variety of different types of assistance to help them remain in their homes, rather than move into a nursing home or another facility far from their community. In general, these Medicaid-funded services provided outside of nursing homes are referred to as “Home and Community Based Services,” or more commonly HCBS.
Under CT’s CFC Program, family members can be hired to provide their loved ones with personal care.
A further benefit to CFC program participants is the option to choose from whom they receive care. Seniors can elect for family members, such as their adult children, to provide personal care services and those individuals can be paid for their efforts. Note: Spouses and legal guardians are excluded from being compensated under CFC in Connecticut.
This concept of “participant directed care” was available to Connecticut residents previously through the Personal Care Assistance Program and CHCPE (Connecticut Home Care Program for the Elders). But with the launch of the CFC Program, those programs were modified to exclude this option. Individuals now direct their own care via the Community First Choice program. A major benefit of CFC is that the funds and benefits are much greater, and the waiting lists for home and community based services have been eliminated. Furthermore, there are no geographic restrictions within the state. CFC is available to all Connecticut residents, regardless of their location, and is overseen by the Department of Human Services.
With CFC, Connecticut has eliminated the waiting lists associated with their other Medicaid home care programs.
For Community First Choice, in addition to being a resident of Connecticut, there are eligibility criteria related both to the financial status and the medical condition / functional abilities of the applicant.
Applicants 65+ years of age must be eligible for the state’s Medicaid program, sometimes referred to as HUSKY C. The income limits vary by marital status. In 2022, single (including widowed) applicants must have income no greater than $1,062 / month. For married couples when both spouses are applying the income limit is $1,697 / month.
Single applicants are limited to $1,600 in countable assets. Countable assets do not include many high value assets, such as one’s home (up to an equity interest of $955,000 in 2022). Married applicants can have higher asset values between the two of them, up to $3,200.
Seniors who have been accepted into one of the Medicaid waiver programs, CHCPE or PCA, and receive a minimum of one service, are able to be self-direct their care via CFC. This enables the program participant to self-direct his / her personal care assistant. The income limit is higher for Medicaid-funded CHCPE, and as of 2022, is $2,523 / month for an applicant. Learn more here.
Financial eligibility is complex; it is recommended that persons unsure of their status consult with a Medicaid professional prior to applying.
Medical (Functional) Requirements
One way to think about the level of care requirements would be that, without assistance, the applicant would otherwise require nursing home level care. A professional assessment is required during the application process to validate this assumption.
For those unsure if their loved one meets this functional requirement, one can examine the level of assistance needed to manage his / her activities of daily living (ADLs). Hands on assistance required to manage 3 or more ADLs, such as bathing, toileting, and eating, will typically make an individual functionally eligible for Medicaid. Alternatively, a behavioral or cognitive impairment, such as advanced dementia (or Alzheimer’s), which requires 24/7 monitoring, plus the need for assistance with 2 ADLs will also normally qualify a candidate.
Services from the Community First Choice program include:
Program participants can also receive assistance from other Connecticut Medicaid programs, such as CHCPE, provided those services are not redundant with those offered under CFC.
For more information about CFC, one can call 1-888-992-8637. One can apply online for Community First Choice, but those who are not already enrolled in Medicaid may find the process confusing. Alternatively, one can apply through their Connecticut Department of Social Services field office. A list of those offices is available here. Candidates should expect the application review to take upwards of 60 days. In addition, they should be prepared to share their personal financial data, as well as receive a professional medical assessment.
Some limited additional information about CFC is available on the state of Connecticut webpage.