Senate Bill 7 from the 2013 Texas Legislature requires the Health and Human Services Commission (HHSC) to put in place a cost-effective option for attendant and habilitation services for people with disabilities who have STAR+PLUS Medicaid coverage.
A federal option, called Community First Choice, allows states to provide home and community-based attendant services and supports to Medicaid recipients with disabilities. This option provides states with a 6 percent increase in federal matching funds for Medicaid for these services.
Who can get Community First Choice services?
To be eligible for Community First Choice services an individual must:
- Be eligible for Medicaid.
- Need help with activities of daily living, such as dressing, bathing and eating.
- Need an institutional level of care.
Community First Choice Services
Community First Choice Services include:
- Help with activities of daily living and health-related tasks through hands-on assistance, supervision or cueing.
- Services to help the individual learn how to care for themselves.
- Backup systems or ways to ensure continuity of services and supports.
- Training on how to select, manage and dismiss attendants.
Texas began the Community First Choice program on June 1, 2015. This means:
- Individuals on a 1915(c) waiver interest list who meet eligibility and coverage requirements may be eligible to get Community First Choice services.
- Individuals already getting services through a 1915(c) waiver will continue to get those services as they do today from their existing providers.
- Community First Choice Provider Training (PDF)
- Community First Choice FAQs (PDF)
- Community First Choice Summary Tool (PDF)
Contracting with Medicaid Managed Care Organizations to Deliver Community First Choice Services
Community First Choice (CFC) is a program that enables Texas Medicaid to provide the most cost effective approach to basic attendant and habilitation service delivery. The services available in CFC are:
- Personal assistance services
- Habilitation services
- Emergency response services
- Support management
STAR+PLUS and STAR Health Medicaid managed care organizations (MCOs) are required to extend a contract to the significant traditional providers (STPs) that provide services in the Community Living Assistance and Support Services (CLASS), Home and Community-based Services (HCS), Texas Home Living (TxHmL), and the Deaf Blind with Multiple Disabilities (DBMD) waiver programs. For the purposes of CFC, STPs are those active providers who had expenditures (paid claims) for services delivered in the waiver programs from September 1, 2013 through February 6, 2015.
The MCOs listed below are in the process of extending contracts to all that have been identified as STPs. The MCOs contracts with STP providers must align with the Health and Human Services (HHS) waiver contract areas. Therefore, STP providers contracted with an MCO will only be able to provide services in the counties that are reflected in their HHS contracts. If you are a waiver provider listed above and you have not been contacted by an MCO in your service area, use the numbers listed below to call the plans:
If you are a provider that currently has a contract with one of the MCOs listed and you want to provide CFC services, call the plan to discuss whether you’ll need a contract amendment to deliver those services.