Community First Choice Closes the Gaps in Community Based Care

Until recently, there was a Catch 22 when it came to getting care in the community. If you are 65 years of age or older, the Connecticut Home Care Program for Elders is available. But for younger people with complex care needs, the options in Connecticut have been limited.

The PCA (Personal Care Assistance) Medicaid Waiver is available, for example, but primarily serves individuals with limited needs and certain conditions, and the program has a cap on the number of slots available. Furthermore, other waiver programs are also limited.

The result is that many people needing care have a difficult time receiving community based services and they have no choice but to enter a skilled nursing facility.

But there is another choice.

A new program, Community First Choice (CFC) is now available in Connecticut for Medicaid recipients at risk of nursing home placement. Unlike existing programs, with CFC:

Enrollment is not capped
There are no age restrictions
Any resident of Connecticut needing institutional level care may apply
Individuals who meet the level of care must meet financial eligibility criteria as well

CFC versus Medicaid

The biggest difference between CFC and Medicaid Waiver programs is that CFC is a “self-directed” program. If a consumer isn’t capable of self-directing, there are a few options. First, an agent acting under a power of attorney or conservator of person can make decisions for the consumer regarding care and services.

Self-direction means that:

You have control over what services you want in the home.
You have the responsibility of managing those services.
You will be able to hire from a pool of qualified staff.
You can hire certain family members and friends.
You will set the hiring requirements for each of your staff.
You can use staff to go out for community activities, doctors’ appointments, and errands.

CFC represents a major shift in the way Connecticut has traditionally managed home and community based services. The shift is toward person-centered care that promotes choice, purpose and meaning in daily life. The individual decides what his or her goals are.

An example of how it works

Here’s a typical scenario that we saw far too often in the past. With CFC, this person’s situation can be completely transformed:

A consumer with cerebral palsy needs assistance for four hours a day, once in the evening and once in the morning. She needs help with bathing, dressing, meal preparation and medication management. If she was 65 or older, she could apply for assistance through the Connecticut Home Care Program for Elders, but because she is 54, her only option for home supports before CFC would have been the PCA Personal Care Assistance Waiver. But she would have had to wait two years on a waiting list to receive services. Now, she can apply to CFC and have an assessment of her needs. Her level of need would determine the stipend the state would allocate to pay for her services. She could then hire her own caregivers, manage the services they provide, and decide when the support is provided. She could stay in the community, get the help she needs – and the funds to pay for the care!

To assist consumers in learning how to self-direct, the program offers support services on how to recruit, hire, train and supervise caregivers. The care plan must demonstrate that the services will help the consumer achieve his or her goals.

The CFC application is available online at: https://ctmfp.com/Apply.aspx. If you are eligible, a care manager will meet with you to assess your needs and help you develop a plan of care.

If you’re not sure if you’re eligible, or if you would like to know how you can become eligible, give us a call. We can help you understand your options and map out a strategy that maximizes your resources while protecting your eligibility for entitlement programs like CFC and others you may be eligible for.