The Community First Choice (CFC) option from Texas Medicaid is a relatively new program that launched in 2015. It enables elderly individuals who would otherwise require nursing home care to receive some types of assistance in their homes. Thereby, preventing unnecessary nursing home placement. Support services such as personal care (assistance with the activities of daily living, like meal prep and bathing) are provided. However, higher level in-home care at home is not available through this program.
Historically in Texas, there have been “home and community-based services” (HCBS) available through Medicaid waiver programs. The primary waiver to which CFC can be compared from a services perspective is the STAR+PLUS Waiver. However, there are several differences that make CFC more beneficial to families. Under STAR+PLUS, enrollment is capped and waiting lists often exist. The federal government has mandated that CFC services are an entitlement. Therefore, waiting lists (or interest lists, as they are called in Texas) cannot exist.
A second key difference is STAR+PLUS is a managed Medicaid program. Services are provided by a managed care organization, like a health insurance HMO. Under CFC, program participants have a much higher degree of control over who provides them with assistance. This flexibility is referred to as consumer-direction. Participants can choose family members, except for their spouses, to provide them with personal care assistance. These relatives can then be paid by Medicaid to provide care.
Under CFC, family members can be paid caregivers for their loved ones.
Eligibility requirements for Community First Choice consider both one’s financial status and need for care.
A person of any age must need help with daily tasks, or Activities of Daily Living, to the degree that, without assistance, the individual would require care in a nursing home or an intermediate care facility. As part of maintaining enrollment, there is an annual re-determination on the individual’s care needs.
Community First Choice is a Medicaid program. Applicants must be financially qualified for regular Medicaid. In Texas, an aged (65 and over) applicant must have a gross income below 100% of the Federal Benefit Level (Supplemental Security Income). In 2020, this totals $783 per month for a single applicant. Couples can have up to $1,175 in joint monthly income. When only one spouse of a married couple is an applicant, the non-applicant spouse may transfer some, or all, of his / her monthly income to the non-applicant spouse to prevent spousal impoverishment. In 2020, as much as $3,216 / month may be transferred to bring the non-applicant’s spouse’s monthly income up to this level.
A person can possess personal assets up to $2,000, and a couple, up to $3,000, not including one vehicle, most household items, and the value of the individual’s home (up to $595,000 in 2020). Married couples are permitted to have a higher level of “countable assets,” provided one spouse is not applying for Medicaid. This is called a community spouse resource allowance, and as of 2020, allows a non-applicant spouse to retain up to $128,640 of the couple’s joint assets. If over the asset limit, it is critical that one does not get rid of their assets (gift them to relatives, sell them for less than they are worth, etc.) in an effort to meet the asset limit. Doing so may be cause for a delay in benefits, as it is a violation of Medicaid’s look back period if such transfers have been made during the 5-years immediately preceding application.
Persons unsure if they meet Texas’ complex Medicaid eligibility requirements, and persons with income or assets over these limits, are encouraged to consult with a Medicaid advising service prior to application. Doing so may help candidates become eligible. Read more.
Services and supports offered under CFC are designed to increase an individual’s ability to lead an independent life, integrating the individual into the community as much as possible. As such, personal or attendant care is provided as well as the option to choose who provides that care. Personal emergency response services (PERS) are covered, helping during those periods when the individual is alone.
Assistance is also provided with the instrumental activities of daily living (IADLs). This includes services such as:
CFC also provides support for health maintenance activities (HMA’s). Assistance such as:
There is technically no limit to the cost of benefits that can be provided under CFC, but the client’s service planning team determines exactly how much support the individual needs.
Interested parties can apply online. Individuals who are already enrolled in one of the Texas Medicaid waiver services are eligible to switch to the Community First Choice program, but there are no requirements that say they must do so.
As this is a relatively new program, limited additional information is available online. For more in-depth information, it is recommended one contact their local Texas Area Agency on Aging. Some limited information is also available on the Texas Health and Human Services’ webpage.