New York Medicaid Community First Choice Option (CFCO): Benefits for the Elderly

Program Description

The Community First Choice State Plan Option, abbreviated as CFCO provides eligible New Yorkers with assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, mobility, toileting, shopping for essentials, meal preparation, and medication management. Health related tasks, such as changing wound dressings can be performed by a home health aid. Other supports are also available, including non-emergency transportation for medical appointments, durable medical equipment, and personal emergency response systems.

Through CFCO, there is an agency provider option for personal attendant services, as well as a consumer directed option. What this means is program participants can choose to hire their own personal caregivers or the state can choose those caregivers on the participant’s behalf. The choose-your-own / self-directed option is also referred to as the Consumer-Directed Personal Assistance Program (CDPAP). Program participants are able to hire, train, manage, and even fire their own care attendants. This is a particularly well-liked option, as friends and select family members can be hired as the care attendant.

CFCO is a relatively new Medicaid option in New York that was made possible via the Affordable Care Act. Long-term care benefits that were previously only available through Medicaid Home and Community Based Services (HCBS) Waivers are now available through the state Medicaid plan. Medicaid HCBS Waivers have enrollment caps, meaning that a limited number of New York residents are able to receive services via any given waiver. However, the Medicaid state plan is an entitlement program, which means that anyone who is eligible to receive services is able to do so. CFCO makes it possible for a greater number of New York residents to receive long-term personal care services and supports for independent living in their home and community, rather than require institutionalization, such as nursing home placement.

 

Eligibility Guidelines

CFCO is available to all New York residents, regardless of age, given they meet the following three requirements:

1. Be living in their home or the home of a relative
2. Have a level of care need that is equal to a nursing facility level of care longtermcare/nursing-home-level-of-care.html
3. Be eligible for the Medicaid state plan - For seniors (65 years of age or older) in 2018, a single individual cannot have income in excess of $842 / month, or put another way, $10,104 / year. Married couples are allowed a slightly higher monthly income, which cannot exceed $1,233 / month ($14,796 / year). There is also an asset limit, which is $15,150 for a single individual and $22,200 for married couples.

Persons Over the Financial Limits
Being over the income and / or asset limit does not necessarily mean one will be denied Medicaid, as one can reallocate income and / or assets to be exempt. However, it is strongly suggested one contact a professional Medicaid planner for assistance in doing so, as NY Medicaid eligibility is complicated and confusing.

 

Benefits and Services

Personal care (attendant) services are provided and include assistance with ADLs and IADLs. ADLs and IADLs include assistance with bathing, personal hygiene, dressing/undressing, using the toilet, mobility, eating, transferring, preparation of meals and cleanup, managing finances, transportation assistance for routine medical appointments, shopping for groceries and other necessary items, light housecleaning, laundry, and medication management. Assistance from a home health care aide, such as Ostomy care, changing wound dressings, and administering medications is also available. Other benefits via CFCO include durable medical equipment, surgical / medical supplies, and Personal Emergency Response Systems (PERS).

At the time of this writing, additional benefits are to be added (and are set to be effective) as of January 1st 2019. This includes home and vehicle modifications, transportation for social outings, assistive technology, transitional services from an institution back into the community, moving assistance, meal delivery, and congregate (group) meals.

Program participants are able to receive services from CFCO and a NY Medicaid Waiver program at the same time, given the services received are not the same.

 

How to Apply / Learn More

Additional information about the CFCO option can be found on the New York State Department of Health’s website. If one is currently enrolled in a New York Medicaid Managed Care Plan and is interested in receiving CFCO services, they should call their care manager to discuss their needs and be referred for a functional assessment for home and community based long-term care services.

As mentioned previously, one must be eligible for the New York state Medicaid program. If not currently enrolled, one can call the Medicaid Helpline at 800-541-2831 or contact their local department of Social Services’ office. Click here for your local county’s contact information.