Program Description
The Community First Choice Option, abbreviated CFCO, is a set of long-term services and supports available through New York State Medicaid. Eligible New Yorkers can receive assistance with their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs), such as bathing, grooming, mobility, toileting, shopping for essentials, meal preparation, and medication management. Health-related tasks, such as changing wound dressings, can be performed by a home health aide. Other supports are also available, including non-emergency transportation for medical appointments, durable medical equipment, and personal emergency response systems.
Two options exist for receiving services via CFCO: through an agency provider, or participants can direct their own care. What this means is program participants can choose to hire their own personal caregivers or the state can choose those caregivers on the participant’s behalf. With the self-directed option, participants hire, train, manage, and even fire their own care attendants. This is a particularly well-liked option, as friends and select family members can be hired as the care attendant. To be clear, spouses cannot be hired to provide care.
CFCO is a relatively new Medicaid option in New York that was made possible via the Affordable Care Act. Long-term care benefits that were previously only available through Medicaid Home and Community Based Services (HCBS) Waivers are now available through the State Medicaid Plan. Medicaid HCBS Waivers have enrollment caps, meaning that a limited number of New York residents are able to receive services via any given waiver.
However, the Medicaid State Plan is an entitlement program, which means that anyone who is eligible to receive services is able to do so. CFCO makes it possible for a greater number of New York residents to receive long-term personal care services and supports for independent living in their home and community, rather than require institutionalization, such as nursing home placement.
Eligibility Guidelines
CFCO is available to New York residents who meet the following requirements:
General Requirements
Financial Requirements
Participants must also meet the financial requirements for the Medicaid State Plan.
Income Limits
For 2024, single seniors (65 years of age or older) cannot have income in excess of $1,732 a month. Married couples with both spouses applying are allowed a slightly higher monthly income of $2,351.
When only one spouse of a married couple is applying, the applicant spouse is allowed to transfer up to $3,853.50 in monthly income to the non-applicant spouse as a Monthly Maintenance Needs Allowance. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted.
Asset Limits
There is also an asset limit: $31,175 for a single individual and $42,312 for married couples with both spouses applying. When only one spouse of a married couple is applying, the non-applicant spouse can keep 50% of the couple’s assets, up to $154,140 (as of 2024). If the couple’s assets are under $74,820, the non-applicant spouse can keep all of the assets, up to this amount.
Over the Financial Limits?
Being over the income and/or asset limits does not necessarily mean an individual will be denied Medicaid, as one can reallocate income and/or assets to be exempt. However, it is strongly suggested one contact a professional Medicaid planner for assistance in doing so. Persons cannot give away assets or sell them for less than fair market value within 60 months of one’s Medicaid application date. This is because doing so is a violation of the Medicaid look-back period and can result in Medicaid denial.
Benefits and Services
Personal care (attendant) services are provided that include assistance with ADLs and IADLs, such as help with bathing, personal hygiene, dressing/undressing, using the toilet, mobility, eating, transferring, preparation of meals and cleanup, managing finances, transportation assistance for routine medical appointments, shopping for groceries and other necessary items, light housecleaning, laundry, and medication management.
Assistance from a home health care aide, such as ostomy care, changing wound dressings, and administering medications is also available.
Other benefits via CFCO include non-emergency medical transportation, assistive technology, transitional services from an institution back into the community, moving assistance, home and vehicle modifications, meal delivery, congregate (group) meals, durable medical equipment, surgical / medical supplies, and Personal Emergency Response Systems (PERS).
Program participants are able to receive services from CFCO and a New York Medicaid Waiver program at the same time, given the services received are not duplicated.
How to Apply / Learn More
Additional information about the CFCO option can be found on the New York State Department of Health’s website. If one is currently enrolled in a New York Medicaid Managed Care Plan and is interested in receiving CFCO services, one should call his or her care manager. Current needs will be discussed and he or she will be referred for a functional assessment for home and community based long-term care services.
As mentioned previously, one must be eligible for the New York State Medicaid program. If not currently enrolled, one can call the Medicaid Helpline at 800-541-2831 or contact his or her local department of Social Services’ office. Click here for your local county’s contact information.
