What are Community First Choice Programs?
Until recently Medicaid provided care services to the elderly three ways: in nursing homes, at home through “HCBS Waivers”, and through regular Medicaid “personal care.” Each has its shortcomings. However, the Affordable Care Act now allows states a fourth option to provide aging care that addresses some of these limitations.
Maryland Medicaid’s Community First Choice (CFC) state plan option aids elderly and disabled state residents who would otherwise require care in a nursing home or intermediate care facility. Via CFC, care services are provided at home, the home of a loved one, or in a foster care home. The best part is that under CFC, there are no caps on the number of eligible people who can be enrolled simultaneously. This means that anyone who meets the eligibility requirements is able to receive services through this program.
The level of assistance provided varies per the needs of the individual. But the primary focus is personal assistance with basic Activities of Daily Living (ADLs), such as bathing and dressing, as well as Instrumental Activities of Daily Living (IADLs), such as meal preparation and transportation.
Under Community First Choice, participants can hire their family members to provide them with care and assistance.
The CFC Program emphasizes self-directed care and home and community-based services (HCBS). This means the program encourages participants to play an active role in the selection of the caregivers who will help them in their homes. With a few exceptions, program participants are permitted to hire their family members to act as their caregivers. The state sets caregivers’ wages within a given range.
CFC and Maryland’s Medicaid Waivers
Prior to Community First Choice, Medicaid paid for “home and community based services” (meaning non-nursing home care) through the Waiver for Older Adults and Medical Assistance Personal Care. With the launch of CFC, services have been re-aligned and the programs renamed, but these waivers still exist. Beneficiaries can still receive the same services, but personal care is now provided under CFC. It is also possible to receive services from regular Medicaid or a Medicaid waiver and through CFC as well, given the services provided are not duplicated. Readers can read more about these other programs by clicking the links below.
Community Options Waiver (formerly the Waiver for Older Adults)
Maryland Community Personal Assistance (formerly Medical Assistance Personal Care)
Maryland Medical Day Care
At a minimum, applicants must have a diagnosed medical condition that demands the need for personal care assistance. In order to qualify medically for CFC, an applicant must require assistance with two ADLs. In addition, the applicant must be eligible for a Medicaid program that includes nursing home services. A higher level of care need, such as a nursing facility level of care, increases the range of assistance services an applicant can receive.
CFC is a Medicaid program and its requirements mirror those requirements. To be eligible for Community First Choice in Maryland, an individual must be a Maryland resident and must qualify financially.
In Maryland, single applicants, 65 years old or older qualify for Home and Community Based Services Medicaid Waivers with incomes less than 300% of the Supplemental Security Income (SSI) Limit. In 2022, this means a gross monthly income of $2,523 or less. Seniors who are enrolled in a Medicaid Waiver qualify for CFC.
Seniors may also qualify for Community First Choice by being eligible for Medicaid via Maryland’s state plan. For the Aged, Blind, and Disabled, this income limit is very low and has not changed in many years. As of 2022, the income limit is $350 / month for a single applicant, and $392 / month for a married couple. That said, persons over the income limits are able to spend their “excess” income on medical and care expenses. Once they have “spent down” their income to the income limit, they are able to qualify for Medicaid. This is known as the medically needy pathway.
It’s important to mention that persons who receive SSI automatically qualify for Medicaid.
People who are not eligible for one of the Medicaid programs that provide nursing home services may still qualify for CFC services if his/her income is below 150% of the FPL. As of 2022, this amount is equivalent to $1,699 / month for a single person.
Eligibility limits for assets, which exclude the value of a person’s home, given its equity is valued under $636,000 and the applicant (or his or her spouse) lives in the home, and certain other personal items, cannot exceed $2,000 or $2,500, depending on the Medicaid eligibility route. (The asset limit for qualification via a Medicaid waiver is $2,000 and for qualification via the Aged, Blind, and Disabled pathway it is $2,500). Married applicants whose spouses are not applying for assistance may keep significantly more money. As of 2022, up to $137,400 in jointly held assets can be allocated to the healthier spouse. This is called the community spouse resource allowance.
Assistance is available to help families or individuals qualify for Medicaid. Read more.
Benefits and Services
Community First Choice budgets are flexible and based on a person’s need. Services are focused on helping individuals stay at home when at risk of nursing home institutionalization. Participants are able to select an agency provider or choose someone from their family or community to provide care. A non-exhaustive list of common benefits follows:
- Supports planning
- Personal assistance with daily tasks
- Home health
- Technology equipment that reduces the need for hands-on assistance
- Durable medical equipment
- Nurse monitoring
- Home-delivered meals
- Personal emergency response services (a.k.a. PERS & MedicalAlert) installation and monthly fees
- Environmental assessments for home or vehicle modifications
- Laboratory work
- Mental health services
- Disposable medical supplies
- Doctor / Hospital Visits
- Financial assistance to enable a move from a nursing home back to a home
How to Apply / Learn More
Community First Choice, unlike Maryland’s Medicaid Waiver programs, by law has no waiting list for services.
To apply for Community First Choice, one must apply for Medicaid. For those who are confident they meet the program’s eligibility requirements, the best way to start an application is through the state’s online Medicaid application. Persons uncertain about their eligibility should consult with an adviser who is familiar with the Maryland eligibility rules before applying. Read more about Medicaid planning.
To find out more about Community First Choice, click here or contact your local area agency on aging. One can also call 410-767-1739, which is the number for Medicaid’s Long Term Care and Waiver Services.