Page Reviewed / Updated - Jan. 2019
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 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.
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 of 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 and is overseen by the Department of Human Services.
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 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 2019, this is less than $17,236 per year. Put another way, an applicant may not have income greater than $1,436 per month. However, married applicants with both spouses applying can have higher incomes, in 2019, up to $23,336 per year. Stated differently, the couple can have as much as $1,945 per month in income. Finally, married applicants whose spouse is not applying can have still higher incomes as Medicaid allows the applicant spouse to transfer a portion of his / her income to the non-applicant spouse. (This is called a monthly maintenance needs allowance). Individuals with a recognized disability or who are 65 and over can have monthly income up to $2,313. In this case, if both spouses are applying, each spouse is covered as a single applicant.
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 $878,000 in 2019). Married applicants can have higher asset values between the two of them up to $3,200. If only one spouse is seeking assistance, the non-applicant spouse is entitled to a greater amount of assets. This is called the community spouse resource allowance.
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 cognitive impairment, such as advanced dementia (or Alzheimer's), which requires 24/7 monitoring, will also normally qualify a candidate.
Services from the Community First Choice program include:
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.
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. In addition, 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.