Are you facing service termination or reduced PCA hours under the Community First Choice (CFC) Medicaid program?
Community First Choice (CFC) is an important Medicaid service that allows people to get personal care assistance (PCA) services at home if they would otherwise have to go to a nursing home for the care they need. You, the consumer, decide when and how personal care is provided.
CFC is a covered Medicaid/HUSKY service under our federally approved state Medicaid plan, not a Medicaid waiver. However, some people are on both a Medicaid waiver for home and community-based services (HCBS) and CFC. These HCBS waivers include CHCPE, PCA, ABI, Mental Health Waiver, DDS, and Katie Beckett. People over income for HUSKY may nevertheless become eligible for Medicaid through an HCBS waiver and qualify for CFC services. The income limit for waivers is higher than HUSKY, equal to three times the SSI payment amount.
As it is a part of Connecticut’s state Medicaid plan, CFC is an entitlement. If you qualify for Medicaid and need care at a level provided in a nursing facility, you are entitled to PCA services up to your needs, regardless of the number of people who need these services. This also means that you are protected by federal rules if the state wants to stop or reduce your CFC services, providing you with a sense of security. DSS must send you a written notice at least 10 days before they can end or even reduce your CFC (or other Medicaid) services.
The written notice must include:
1. What the change is
2. Why the change is being proposed
3. The specific law that the change is based on
4. Information that you can appeal the change and how to do so
5. A statement that you can keep the full benefits until a hearing decision is made. (The state can ask for reimbursement for services paid for during this period if you end up losing the appeal, but this rarely, if ever, happens.)
See 42 C.F.R. §§ 431.210 (available at eCFR :: 42 CFR 431.210 -- Content of notice.) and § 431.230 (available at eCFR :: 42 CFR 431.230 -- Maintaining services.)
For possible assistance with CFC, please contact Sheldon Toubman, Litigation Attorney, Disability Rights CT, at sheldon.toubman@disrightsct.org or 475-345-3169
