Community First Choice State Plan Option from Connecticut Medicaid

Program Description

Connecticut Community First Choice (CFC) is a new 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, and avoid having to move to 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 CT.

It should be noted that this concept of "participant directed care" was available to CT residents previously through the Personal Care Assistance Program and CHCPE, but with the launch for the CFC Program, those programs are being modified to exclude this option. Individuals who are directing their own care move automatically to the Community First Choice program. Initially, this may cause minor logistical challenges for residents. However, the fund and benefits of Community First Choice are much greater. 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 CT residents regardless of their location. 

With CFC, Connecticut has eliminated the waiting lists associated with their other Medicaid home care programs.

 

Eligibility Guidelines

For Community First Choice, there are eligibility criteria related both to the financial status and the medical condition / functional abilities of the applicant.

Financial Requirements
Applicants under 65 must be eligible for the state's Medicaid program, sometimes referred to as HUSKY Health. Single (including widowed) applicants must have income within 138% of the Federal Poverty Level. For 2018, this is less than $16,753 per year. However, married applicants with both spouses applying can have higher incomes, in 2018, up to $22,715 per year. Finally, married applicants whose spouse is not applying can have still higher incomes as Medicaid allows the couple to allocate some joint income to the non-applicant spouse. Individuals with a recognized disability or who are 65 and over can have monthly income up to $2250.

Disabled and aged 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 a value of $858,000 in 2018). Married applicants can have higher asset values between the two of them up to $3,200 or higher still if only one spouse is seeking assistance.

Financial eligibility is complex; it is recommended that persons unsure of their status consult with 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 requirement, one can examine the level of assistance needed to manage of one's 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 cognitive impairment such as advanced dementia (or Alzheimer's) which requires 24/7 monitoring will also normally qualified a candidate.

 

Benefits and Services

Services from the Community First Choice include:

  • Personal care assistance with for ADLs
  • Assistance with the Instrumental ADLs
  • Home delivered meals
  • Home safety modifications (such as ramps, bars or bathroom re-models to accompany a wheelchair) up to a value of $10,000.
  • Personal care and assistance with the instrumental activities of daily living can be "consumer directed" by the program participant, meaning they can choose to hire friends or family members to provide these services.

Program participants can also receive assistance from other CT Medicaid programs, such as CHCPE, provided those services are not redundant with those offered under CFC.

 

How to Apply / Learn More

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 CT 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 and they should be prepared to share both 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.