The Centers for Medicare and Medicaid Services (CMS) released on April 26 a draft of final rules to implement the Community First Choice Option enacted under section 2401 of the Affordable Care Act (ACA). The final rules are scheduled for official publication in the Federal Register on May 7. Proposed rules were published in the Federal Register on February 25 last year. The CFC option enables a state to receive a six percentage point increase in its Medicaid Federal medical assistance percentage (FMAP) for services under the new option if the state obtains CMS approval of a state Medicaid plan amendment. CMS has estimated that this could represent up to $3.7 billion in increased federal Medicaid reimbursement in the aggregate to all states. States may convert home and community-based services waiver programs to the CFC option if they meet all CFC requirements. Maintenance of effort rules apply to Medicaid expenditures over the first 12 months.
A state can obtain increased Medicaid FMAP on expenditures for consumer-directed, home and community based attendant services and supports, where these services are provided to disabled individuals who need help with activities of daily living, instrumental activities of daily living, and health-related tasks. The CFC option also allows increased Medicaid FMAP on other items such as expenditures for rent deposits, utilities deposits, and household furnishings, where needed to help transition consumers from institutional to community settings, and for skills development and training for consumers on how to select, manage, and dismiss attendants who aren’t satisfactory to them. States must cover specified CFC core services, may cover additional CFC services, and must meet CFC data collection, reporting, quality assurance, and continuous quality improvement provisions. Services and supports may be offered through conventional provider agencies or paid for through direct cash payments or vouchers to consumers and through financial management entities such as Public Partnerships LLC.