Community First Choice Option - the NEW Medicaid Personal Care

Medicaid Personal Care (MPC): A Medicaid program that is allowed under Washington State’s Medicaid State Plan, this program provides assistance with activities of daily living to individuals who receive Social Security Income (SSI) or are approved for other Categorically Needy (CN) medical programs. Services are available in the client’s own home, adult family homes, and boarding homes with an Adult Residential Care (ARC) contract. The program is administered by Home and Community Based Services (HCBS) and Division of Developmental Disabilities  (DDD) administrations.

An assessment is done by a case manager, nurse or social worker from DDD, HCS or Area Agency on Aging (AAA). Clients must meet the functional criteria based on the social service assessment  AND the financial eligibility based on eligibility for a non institutional CN Medicaid program.

MPC is a state plan entitlement program. If clients are eligible for CN without using the higher income and resource standards for institutional  eligibility and meeting the functional eligibility criteria for the program, they are “entitled” to MPC. This makes MPC the priority Medicaid program for personal care services and is usually the first program considered. This is because waiver programs that provide personal care such as HCBS Waivers or DDD Waivers are restricted to a certain number of clients.  MPC services include personal care services and CN medical program. MPC services are authorized by HCBS and DDD. 

The Community First Choice Option (CFCO) would provide individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services.  CFCO would support the Olmstead decision by giving people the choice to leave facilities and institutions for their own homes and communities with appropriate, cost effective services and supports.  It would also help address state waiting lists for services by providing access to a community-based benefit within Medicaid.  The option would not allow caps on the number of individuals served, nor allow waiting lists for these services.

There are two significant fiscal reasons that combine with increased independence and self sufficiency for individuals with developmental disabilities.

~ A significant enhanced Federal Medical Assistance Percentages (FMAP) of 6% will be provided to encourage states to select this option. This amounts to an additional $51 million for Washington State EVERY YEAR!

~ A key component of the CFCO is that personal care providers would be teaching skills to clients instead of just providing the service. For example, many individuals with developmental disabilities could cook nutritious meals but just don’t know how, so the care provider fixes the meal. For many, having a care provider teach them how to do it leads to more independence and less reliance on a provider.

The CFCO Waiver won’t be available until October 2011 but now is the time to start preparing. The new federal rules for the CFCO can be found at: http://www.ofr.gov/OFRUpload/OFRData/2011-03946_PI.pdf and the Governor and Legislators in Washington State need to take the lead and direct the Division of Developmental Disabilities to apply for the CFCO.

Watch for more information to come as we learn specifics of how and when this state plan service could be adopted.

Diana Stadden
Policy & Advocacy Coordinator
The Arc of Washington State