On December 30, the Centers for Medicare and Medicaid Services (CMS) issued a guidance package for states regarding the Community First Choice (CFC) State Plan Option that includes three documents: 1) a State Medicaid Director (SMD) letter, 2) a state plan amendment (SPA) pre-print, and 3) a technical guide that provides information to assist states with completing the pre-print. The Community First Choice option was created by the Affordable Care Act (ACA) and is authorized by Section 1915(k) of the Social Security Act.
The SMD outlines specific state activities that are eligible for matching FMAP funds, and what states must do to document those activities. It also includes level of care and financial eligibility requirements, reviews required and optional services and service models under CFC, person-centered planning, and applicable HCB setting exceptions.
In the guidance documents, CMS says that states can use CFC to help reduce the administrative complexity that comes from having multiple authorities providing similar services across different populations. Additionally, they notes that this program allows additional flexibility to states in delivering services. The program may not be capped, which means that any eligible individual under the program is entitled to benefits, which does not permit waiting lists under this authority.
In the guidance, CMS clarified language that discusses natural supports. The section of regulation at issue reads, “Natural supports cannot supplant needed paid services unless the natural supports are unpaid supports that are provided voluntarity to the individual in lieu of the attendant.” CMS clarified that this language is “to set forth the requirement that informal caregivers, family members and friends cannot be required to provide unpaid supports as a condition of an individual receiving CFC services, nor can the beneficiary be required to accept such services.” CMS noted, however, that “the identification of natural supports in the assessment is an important aspect in determining an individual’s needs.” The agency further states that this language “does not require that caregivers that were previously unpaid should become paid caregivers under the CFC benefit, nor does this require that caregivers need to be paid beyond the paid hours authorized in the plan.”
Eight states have received approval of or have submitted applications for CFC plans since it became available in 2011 (California, Connecticut, Maryland, Montana, New York, Oregon, Texas, and Washington), and several others are in the process of establishing CFC state plan options.