CDCAN REPORT #196-2011: Community First Choice Option proposal sent to federal government by Brown Administration

BROWN ADMINISTRATION SUBMITS "COMMUNITY FIRST CHOICE OPTION" STATE PLAN AMENDMENT TO FEDERAL GOVERNMENT - WOULD SIGNIFICANTLY INCREASE FEDERAL MONEY FOR IHSS

Advocates Praise Department of Social Services for Moving Swiftly On Proposal Before Final Federal Regulations Have Been Issued - 2011-2012 State Budget Assumes State Will Win Approval of Proposal and Draw Down $128 Million In Increased Federal Dollars In Current Budget Year - No Impact to State Budget Trigger Cuts

SACRAMENTO, CA (CDCAN)  [Last updated 12/06/2011 01:00 PM] -  The Brown Administration, in an effort to move swiftly to capture significantly more federal matching Medicaid dollars for the In-Home Supportive Services program, submitted on December 1st a "State Plan Amendment" (or "SPA") covering a five year phased in process under a new Medicaid community-based services program called the "Community First Choice Option".

The Community First Choice Option is part of the federal health care reform act - the "Affordable Care Act of 2010", enacted on March 23, 2010.  One of the provisions of that act created the Community First Choice Option under the federal Social Security Act section 1915(k) allowing for increased federal matching funding for new home and community-based attendant services and supports. In California the proposal would essentially cover most - but not all - of the existing IHSS program (the parts of the IHSS  program not covered by the Community First Choice Option funding would still continue using its existing funding sources)

The proposed amendment was submitted by the Department of Health Care Services, the state agency that administers California's Medicaid program (called "Medi-Cal") and requires approval from the federal Centers on Medicare and Medicaid Services (CMS), the federal agency that oversees both programs.  If approved by the federal government, services under the Community First Choice Option would be matched by a 6% increase in federal matching funds - 56% instead of the normal 50% match.

A copy of the 58 page proposed amendment to California's State Medicaid Plan is attached to this CDCAN Report, titled "2011-12-01 - COMMUNITY FIRST CHOICE OPTION STATE PLAN AMENDMENT 11-034 (FINAL 12-1-11).pdf". [CDCAN Note: The document was saved as a document pdf file, and persons who are blind or sight impaired should be able to read it using a screen reading device.] The document can also be downloaded from the Department of Social Services website at:  http://www.cdss.ca.gov/agedblinddisabled/res/pdf/CFCO_SPA_11-034(FINAL12-1-11).pdf

Prior to submitting the proposed amendment to the federal government, the Department of Social Services, the state agency that oversees statewide the IHSS program.hosted on November 17th the first meeting of an appointed stakeholder group formally known as the "Community First Choice Option (CFCO) Development and Implementation Council".   After hearing a general outline of what the proposal would include, the council, along with other advocates, department and legislative representatives who attended the public meeting,  unanimously agreed that the department should take immediate steps to finalize and submit the proposed State Plan Amendment.

Those steps that the council - and others attending - enthusiastically supported included a proposal that would move forward - swiftly - in several phases.

• Phase One - would include transitioning eligible participants in the existing Personal Care Services and In-Home Supportive Services Plus Option programs into the new Community First Choice Option (as detailed in the proposed State Plan Amendment submitted to the federal government).
• Future phases will broaden the assessment process to ensure a "No Wrong Door" approach to provision of home and community-based long-term services and supports and will establish and/or expand permissible services for better health outcomes.

Federal requirements under the Community First Choice Option requires that any state submitting a proposal must, among other things, create a statewide "Community First Choice Council" composed of a majority of persons who use the in home community based services (IHSS or similar in-home service) and is tasked with helping to develop and review the proposal before the State submits it to the federal government.

Department of Social Services Praised by Advocates and Policymakers for Quick Action

• The Department of Social Services under the Brown Administration decided to move quickly in developing a proposal and meeting other initial federal requirements, including formation of the Community First Choice Council, even though final federal regulations on the program have not yet been issued (proposed regulations were issued in February 2011, but final regulations have not yet been issued).
• Department officials wanted to move now - instead of waiting for final federal regulations -   to give California a better chance of winning early approval of its proposal while Community First Choice program funding is still available - and to capture those dollars as early as possible.
• Advocates and legislators and legislative staff at the November 17th stakeholder meeting praised the Department of Social Services for its quick response to this new federal Medicaid program.

New Program Could Have Major Impact On Saving State General Funds and Maintaining Services

• The Community First Choice Option  proposal is for a new Medicaid program that, if accepted by the Obama Administration, could have major impact in saving State general funds while helping to maintain and possibly expand its In-Home Supportive Services program and other programs.
• The new possible program funding was already included in the 2011-2012 State Budget with projected new federal money of about $128 million during the current budget year. While the proposal - if approved by the federal government -  would not impact the State budget "trigger cuts" that include automatic reductions to many programs including a 20% across the board cut in service hours to all persons in the In-Home Supportive Services program (with certain exceptions) - it would prevent other major cuts to the IHSS program. [CDCAN Note: The state budget "trigger cuts" impacting IHSS have been, as previously reported, stopped - at least temporarily until a December 15th hearing by a federal district court in Oakland].
• In addition, in later years, as the State budget situation improves, the Community First Choice Option program funding could be expanded to help maintain and improve other programs that serve people with disabilities and seniors, including possibly services and supports for people with developmental disabilities in supported living and independent living type services.
• The Community First Choice Option is part of the larger federal health care reform act enacted in March 2010, and became effective October 1, 2011 and will provide to those states applying a 6% increase in their federal matching Medicaid funds for their services covered under their approved Community First Choice Option proposal.  Not every state that applies will necessarily have their proposal accepted.

Why This New Medicaid Option Is Important to California

• All 50 states currently have an option to provide personal care services through their Medicaid State Plans - meaning, it is a Medicaid "optional benefit".
• California, and 34 other states currently provide personal care services, known as In-Home Supportive Services (IHSS).
• The new Medicaid "Community First Choice Option" - for those states that apply for funding under the new program - could expand those existing programs if the state applying has them.
• The "Community First Choice Option"  allows states to open eligibility to people at higher incomes and to offer additional services. *  One crucial and major selling point for a state such as California - facing enormous on-going budget deficits, is that the Community First Choice Option provides to the states that apply, an increased federal matching payment (for example, in California the matching funds from the federal government for this program would be 56% instead of the usual 50%).  That could mean tens of millions of more federal funds that would save critical State general fund dollars.
• Community First Choice Option, many policy makers and advocates believe, could provide opportunities for California to expand or improve its Medicaid home and community-based services. The Community First Choice Option funding could eventually - depending on how California crafts its initial and later proposals - to cover other home and community based programs such as Supported Living Services and Independent Living Services under the regional centers that serve people with developmental disabilities if certain eligibility issues can be resolved.
• The potential increased federal matching funding under the Community First Choice Option was included in the 2011-2012 State Budget - projected at $128 million -  as a reason to avoid making additional cuts to IHSS - though it was not linked in the budget to the "trigger cuts".

Community First Choice Council Membership

The following persons were appointed by the Department of Social Services to the Community First Choice Council.  As mentioned, the Community First Choice Option requires that any state applying must, among other things, create a statewide "Community First Choice Council" composed of a majority of persons who use the in home community based services (IHSS or similar in-home service):

• Consumers (listed in alphabetical order):
  • Charlie Bean
  • Mark Beckwith
  • Chris Brown
  • Donna Brown
  • Lisa Brown
  • Tim Davis
  • Sylvia Drzewiecki
  • Connie Frenzel
  • Jene McCovey
  • Ramiro Montoya
  • Charlie Phillips
  • Michelle Rousey
  • Anna Wang
  • Janie Whiteford 
• Unions, Advocates, Organizations, Local Government (listed in alphabetical order by the person):
  • Kristina Bas-Hamilton, UDW (United Domestic Workers)
  • Deborah Doctor, Disability Rights California (DRC)
  • Katherine Hsiao, National Senior Citizen Law Center
  • Diane Kaljian, CWDA (California Welfare Directors Association)  – Sonoma County
  • Rebecca Malberg, SEIU - UHW (Service Employees International Union - United Healthcare Workers)
  • Andrea Mourningham, SEIU - ULTCW (Service Employees International Union - United Long Term Care Workers)
  • Marty Omoto, CDCAN (California Disability Community Action Network)
  • Gary Passmore, California Congress of Seniors
  • Debra Roth, SEIU – State Council
  • Jeff Thom, California Council of the Blind
  • Greg Thompson, CAPA – PASCIA (California Association of Public Authorities and the Personal Assistance Services Council - Los Angeles)
  • Casey Young, AARP 
• Observers:
  • Various advocacy groups, state agencies and legislative staff including the Department of Health Care Services (oversees the state's Medi-Cal program), the California Health and Human Services Agency (oversees all the various health and human services departments including the Department of Social Services, Developmental Services, Health Care Services, and Mental Health), California Association of Public Authorities, various Assembly and State Senate legislative and budget committee staff members.  

File Attachments: 

2011-12-01 - COMMUNITY FIRST CHOICE OPTION STATE PLAN AMENDMENT 11-034 (FINAL 12-1-11).pdf (408.79 KB)