Wednesday, March 23, 2016

HHS Report: Community First Choice

Lilly Hummel

The Department of Health and Human Services published a final report evaluating the impact of the Community First Choice benefit, created by the Affordable Care Act to allow states the option of providing home and community-based (HCBS) attendant services through their State Plan. Although the report generally concludes that more research is needed to fully assess the impact of the CFC benefit, it did find that most individuals served by CFC were previously receiving HCBS under a different authority in the first four states to have their State Plan Amendment implemented: California, Maryland, Montana, and Oregon. Key background and findings from the report includes:
  • As of July 17, 2015, 12 states submitted State Plan Amendments (SPA) to implement the CFC benefit, 3 of which subsequently withdrew, 7 were approved, and 2 were under review.
  • Both states that either adopted CFC and those that actively considered and did not adopt CFC discussed the need for and complexity of maintaining existing HCBS programs alongside the CFC as part of their analysis when considering this new benefit.
  • The majority of individuals served by CFC are adults and children under the age of 65, although a sizable minority were elderly. In particular in California and Maryland, they tend to be older (over 65)—with 20 to 25 percent over 85—in contrast to a lower proportion of seniors served through CFC in Oregon and Montana.
  • Primary reasons for implementing the CFC benefit include: the elimination or reduction of waitlists for HCBS; the expansion of HCBS access for populations that were excluded from or underserved in the State Plan Personal Care benefit and HCBS waivers; the expansion of HCBS service options; and the enhanced federal spending match.

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