Community First Choice: HHS Releases Final Rule

Members | April 19, 2011

The U.S. Department of Health and Human Services (HHS) released a final rule for the Community First Choice Option (CFC), Section 2401 of the Affordable Care Act (ACA), which was published in the Federal Register on May 7.

The U.S. Department of Health and Human Services (HHS) released a final rule for the Community First Choice Option (CFC), Section 2401 of the Affordable Care Act (ACA), which was published in the Federal Register on May 7. 

The final rule sets out in Medicaid a “Community First Choice Option." This final rule, which was only for Community First Choice, will increase federal funding for personal care services paid by Medicaid. 

It is important to advocate for your state to apply for the Community First Choice waiver in order to have access to these additional federal funds. The final rule states that after much discussion and consideration of the impact of each option discussed, HHS concluded that further discussion and consideration on the issue of HCBS setting is still needed.  

HHS still has not finalized the language proposed at 441.530 (settings). Rather, HHS will issue a new proposed regulation that will establish setting criteria for Community First Choice developed as a result of the comments received.

HCBS Characteristics

The HCBS Characteristics final rule that covers all the 1915 (c) waivers has still not been released. We are still waiting for the HCBS Character final rule. The HCBS final rule has still not been released. 

About the Community First Choice Option

Beginning in October of 2011, the Community First Choice Option program from the Affordable Care Act option will allow states to receive a 6% increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid. States may also cover costs related to moving individuals from an institution to the community, such as security and utility deposits, first month’s rent, and purchasing basic household supplies. 

The Community First Choice Option could provide states with an additional $3.7 billion in increased federal funding to provide personal care services in the community. States would be required to develop "person-centered plans" and to establish a Development and Implementation Council. This Medicaid state option is an opportunity for states to increase federal funding for personal care services. 

The Centers for Medicare and Medicaid Services (CMS) on September 4th, 2012 announced its approval of California’s State Plan Amendment (SPA) to enact the Community First Choice Option. The SPA approval will provide the state with an estimated $573 million in additional federal funds during the first two years of implementation in its effort to continue to prioritize an individual’s ability to reside in one’s community rather than in institutional care.

Community First Choice will enhance Medi-Cal’s ability to provide community-based personal attendant services and support to seniors and persons with disabilities to certain enrollees who otherwise would need institutional care. California immediately will begin claiming the Community First Choice federal funding, which is retroactive for most In-Home Supportive Services (IHSS) program services provided since Dec. 1, 2011.

HHS posted proposed rules, which describe the details of the program and solicit public comment.

LeadingAge submitted comments to address a number of concerns about the proposed rule that relate to limitations on where the individual on Medicaid resides, eligibility, the implementation council within the state and the use of funds for technology.