Texas implemented the Community First Choice program June 1, 2015.
What’s Community First Choice?
- The “Community First Choice Option” allows States to provide home and community-based attendant services and supports to eligible Medicaid recipients under their State Plan.
- CFC is a Medicaid State Plan entitlement service and must be provided to those individuals that meet the eligibility criteria.
- This State plan option was established under the Affordable Care Act of 2010. (Source: Medicaid.gov)
- This option provides states with a 6% increase in federal matching funds for Medicaid for these services. (Source: TxHHSC)
Eligibility
To be eligible for CFC services, an individual must:
- Be a child or an adult who is receiving Medicaid
- Require an institutional level of care (like required for CLASS, MDCP, or HCS) documenting that they would qualify for one of these:
- A nursing facility – based on physical needs
- An institution of mental disease – based on mental health needs
- An intermediate care facility for individuals with an intellectual disability or related condition – based on intellectual and developmental needs
Why is this good news!?!
Individuals receiving Medicaid will be eligible to request habilitation (attendant care) through Community First Choice.
- If the Medicaid recipient has traditional Medicaid, they will call the PCS Intake Line (1-888-276-0702) to request an assessment.
- If the Medicaid recipient has STAR or STAR+Plus Medicaid, they will call their Managed Care Organization (MCO) to request Community First Choice.
- If their needs are due to a physical or medical impairment, the MCO will complete the level of care assessment.
- If their needs are based on IDD (Intellectual & Developmental Disabilities) or mental illness, the LIDDA will complete the LON.
- Many times the MCO ignores the request for CFC if the LIDDA has not uploaded a level of need to the Medicaid computer. I highly recommend also contacting the LIDDA for your county and also making the CFC request. Follow this link and enter your county to find the LIDDA for your area.