A Comparative Analysis of State Implementation of the Community First Choice Program

Area of Science:

• Health Policy
• Public Health
• Health Services Research

Background:

• The Patient Protection and Affordable Care Act introduced Community First Choice (CFC), an optional Medicaid benefit.
• CFC offers expanded home and community-based services (HCBS) for older adults and individuals with disabilities.
• States adopting CFC receive a higher federal matching rate for these services.

Purpose of the Study:

• To examine the state-level implementation of the Community First Choice (CFC) program.
• To identify factors that facilitated and challenged CFC adoption and implementation.
• To inform future state strategies for expanding HCBS benefits.

Main Methods:

• Comparative case study analysis of state-level CFC implementation.
• Examination of facilitators and challenges encountered by adopting states.

Main Results:

• Consultation with the Centers for Medicare and Medicaid Services (CMS) facilitated CFC implementation.
• Challenges included pre-existing programs, insufficient stakeholder engagement, tight timelines, and limited staff resources.
• Eight states have adopted the CFC program to date.

Conclusions:

• States should proactively engage with CMS during HCBS benefit implementation.
• Addressing stakeholder engagement, resource allocation, and timelines is crucial for successful HCBS expansion.
• Findings offer insights for states implementing HCBS enhancements under the American Rescue Plan Act.