ARPA Project Highlight - Community First Choice

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March 2022

Project Category: Support Post-COVID-19 Recovery & Innovation

direct care worker assisting a woman in her home


Community First Choice (CFC) was established by the Affordable Care Act in 2010 and allows the Department to offer attendant care services on a state-wide basis to eligible members, instead of only those who meet the criteria for a 1915(c) waiver. CFC is an option available to states to provide home and community-based services (HCBS) through the Medicaid State Plan that allows participants to direct their own care as much as possible and promote independence in the community.

What services are provided in CFC?

In a CFC program, members can get services that help with Activities of Daily Living (ADLs) and with Instrumental Activities of Daily Living (IADLs). ADLs are activities that you need to do to be able to live, like moving from place to place, using the toilet, washing, and eating. IADLs are activities that you need to do to be able to live independently, including house cleaning, shopping, and managing your money. CFC would offer support with both ADLs and IADLs according to a member’s specific needs identified in the individual’s person-centered support plan.

In addition, CFC would offer help with health-related tasks like organizing medications and remembering to take them or helping a member maintain medical devices that they need.

Finally, one of the primary goals of CFC is to put members in control of their own care as much as possible.

In addition to the benefits outlined above, there are other optional benefits that states can include in CFC which will be discussed during the Department’s stakeholder engagement process. 

How is ARPA Funding Tied to CFC in Colorado?

The Department will use ARPA funding to cover the administrative costs associated with the development and implementation of CFC, including system costs, stakeholder engagement, staff, and a new Wellness Education Benefit. CFC implementation is set to occur by Jan. 1, 2025. Once implemented, the state would qualify for a 6% ongoing federal enhanced match on the services that make up the CFC option.

To develop and implement CFC, the Department will need the following:

  • CFC Council: The CFC Council will collaborate with the Department on the design and implementation of a CFC option in Colorado. The CFC Council primarily consists of individuals with disabilities, those 65 years or older, and their representatives. The experience and expertise of the council will help ensure that CFC is implemented in a way that best meets the needs of Coloradans with disabilities. The Department is recruiting participants for the CFC Council through April 1, 2022. Please see the Call to Action below for details. 
  • System Changes: System changes will be required to add the existing HCBS benefits into the State Plan which necessitates changes to the provider subsystem, financial subsystem, prior authorization subsystem, the prior authorization system, and the care and case management system. This work will include ongoing testing and maintenance to ensure the changes made were accurate and operating correctly.
  • Wellness Education Benefit: This new benefit will include sending participants a newsletter that provides educational material tailored to improve health outcomes and information on how to use Medicaid resources to improve community integration and independence. Receiving the newsletter will be considered a waiver service and helps ensure all participants in CFC also receive waiver services. The Department will utilize a contractor to develop and manage the Wellness and Education Benefit. The cost of this benefit will be absorbed by the Department once CFC cost savings are realized.

Next Steps for the CFC ARPA Project: The Department will launch the new CFC Council on May 4, 2022, which will serve as the primary vehicle of stakeholder engagement for the project. You can find information about and keep up to date on the CFC Council on the Department’s CFC page or receive email updates by signing up for the CFC Updates Email List. All CFC Council meetings will be open to the public.