Connecticut Medicaid (Husky Health) Community First Choice (CFC) Program is a suite of long-term services and supports for persons who are elderly or disabled and require care equivalent to that which is provided in a nursing home. Intended to prevent and delay unnecessary nursing facility admissions, assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is provided. This includes personal care assistance (i.e., bathing, dressing, toileting, and eating) and homemaker services (i.e., preparing meals, light housecleaning, and laundry). Other benefits might include help with health related tasks (i.e., diabetes management), assistive technology, and educational services to increase a program participant’s independence. Assistance can also be provided in helping one move back home from a nursing home facility.
CFC is a self-directed program that allows program participants to choose the in-home services they require for independent living and from whom to receive them. This includes the ability to hire a friend or relative as a personal care attendant. While one’s adult child can be hired to provide such care, a spouse or legal guardian cannot be hired. Program participants who are unable to self-direct their own care can have a representative do so on their behalf. A fiscal intermediary handles the financial aspects of employment responsibilities, such as tax withholding and caregiver payments.
Program participants must reside in their own home or the home of a friend or relative. With few or no exceptions, program participants cannot live in an assisted living residence or an adult foster care home.
CFC services are an entitlement; meeting the state’s Medicaid eligibility requirements guarantees one will receive benefits. This means there is never a wait list to receive Community First Choice benefits.
The Community First Choice Program is a Medicaid State Plan Option that was created by the Affordable Care Act (ACA). It is a 1915(k) State Plan Amendment. In Connecticut, Medicaid is called HUSKY Health, and the Medicaid program specific to the aged, blind and disabled is called HUSKY C.
What is the Community First Choice Option?
The Community First Choice (CFC) Option, established by the Affordable Care Act, allows states to provide limited home and community based services (HCBS), such as personal care assistance, via their state’s Regular Medicaid program. Previously, states mainly provided HCBS via 1915(c) Medicaid Waivers, which limit the number of participant enrollment slots. Therefore, wait lists commonly exist. In contrast, CFC benefits are available via a state’s Regular Medicaid program, which does not limit the number of program beneficiaries. This means the availability of home and community based services via the CFC Option is open to anyone who meets the eligibility criteria.
CFC program participants are allotted a budget with which to purchase home and community based services and supports. Ways in which one might spend their budget include the following.
– Assistive Technology – i.e., personal emergency response systems
– Educational Services – to help increase one’s independence and learn how to manage one’s care workers
– Environmental Modifications / Home Modifications
– Health Coach
– Home Delivered Meals
– Nurse
– Personal Care Attendant – assistance with daily living activities, such as bathing, dressing, mobility, eating, preparing meals, light housecleaning
– Support and Planning Coach
– Therapists (Speech, Occupational, Physical)
– Transportation Assistance
– Transitional Services – assistance in moving from an institutional setting back home
The CFC suite of long-term care services is for Connecticut residents of all ages who are eligible for Connecticut’s State Medicaid Plan, or specific to seniors (65+ years old) and adults with disabilities, the HUSKY C program. The criteria below is relevant for this population.
The American Council on Aging provides a free, quick and easy Connecticut Medicaid Eligibility Test for seniors. Start here.
Income
Effective 3/1/24, the individual applicant income limit is $1,234 / month. For married couples, with both spouses as applicants, the combined income limit is $2,002 / month. When only one spouse is an applicant, the individual income limit is used. To be clear, the non-applicant spouse’s income is not counted towards the income eligibility of their spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance.
In Connecticut, there is a minimum income allowance of $2,555 / month (eff. July 2024 – June 2025). This allows an applicant spouse to supplement their non-applicant spouse’s monthly income, bringing their income up to this amount. In 2024, there is also a maximum income allowance of $3,853.50 / month. While this potentially allows a non-applicant spouse a higher income allowance, any additional amount above the minimum income allowance is dependent on one’s shelter and utility costs. A Spousal Income Allowance, however, can never push a non-applicant’s total monthly income over $3,853.50.
There are other avenues through which Connecticut seniors might be financially eligible for the Community First Choice (CFC) Program. Persons enrolled in the Community Home Care Program for Elders (CHCPE) Waiver may self-direct their personal attendant care via CFC. Persons who qualify for CFC via the waiver program are allowed a higher monthly income than those who qualify via the state’s Regular Medicaid Plan.
Assets
In 2024, the asset limit is $1,600 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,200. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can retain up to $1,600 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a Community Spouse Resource Allowance (CSRA) to prevent spousal impoverishment.
The CSRA allows the non-applicant spouse to keep 50% of the couple’s assets, up to $154,140. If 50% of the couple’s assets falls under $50,000, the non-applicant spouse can keep all of the couple’s assets, up to this amount.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Assets should not be given away or sold under fair market value prior to applying for long-term care Medicaid. This is because CT Medicaid has a 60-month Look-Back Rule for applicants of long-term home and community based services. Violating this rule results in a Penalty Period of Medicaid ineligibility.
To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our Spend Down Calculator.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for eligibility purposes, Connecticut Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return, and in 2024, their home equity interest is no greater than $1,071,000. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– The applicant has a spouse living in the home.
– The applicant has a child under 21 living in the home.
– The applicant has a disabled or blind child living in the home.
While one’s home is generally safe from Medicaid’s asset limit, it is not necessarily safe from Medicaid’s Estate Recovery Program. More on the potential of Medicaid taking the home.
An applicant must require a Nursing Facility Level of Care (NFLOC) to be eligible for CFC services. It is unclear as to the exact assessment tool used to make this level of care determination. However, one’s ability / inability to independently complete the Activities of Daily Living is considered. These activities include bathing, dressing, eating, toileting, mobility, transferring, and continence. Relevant to many persons with Alzheimer’s disease or a related dementia, orientation, memory, judgment, and problematic behaviors, such as wandering or disrobing in public, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of Medicaid planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Connecticut has a Medical Spend-Down Program for applicants who have high medical expenses relative to their income. Via this program, applicants are permitted to spend “excess” income on medical expenses and health care premiums, such as Medicare Part B, in order to meet Medicaid’s income limit. More on the Medically Needy Pathway.
When persons have assets over the limits, one option is to “spend down” assets. Examples include paying off debt, making home improvements (i.e., updating heating and plumbing), and purchasing pre-paid funeral and burial expense trusts called Irrevocable Funeral Trusts. Though no longer a strategy frequently used, married couples with a significant amount of assets sometimes get a Medicaid Divorce to preserve assets for the non-applicant spouse. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in Connecticut to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid / HUSKY Health eligibility. There are also planning strategies that not only help one meet Medicaid’s financial criteria, but also protects assets from Medicaid’s Estate Recovery Program, preserving them for family as inheritance. These strategies often violate Medicaid’s 60-month Look-Back Period, and therefore, should be implemented well in advance of the need for long-term care. However, there are some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid Planner.
Prior to submitting an application for CFC services, applicants need to ensure they meet Connecticut’s Medicaid eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, bank statements up to 60-months prior to application, and proof of income. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.
Persons can apply for the Community First Choice Program online, over the phone by calling 2-1-1 and choosing option 3, or by contacting their CT Department of Social Services (DSS) Field Office. A functional needs assessment will be completed as part of the application process.
Learn more about the Community First Choice Program. Persons can also call the Department of Social Services at 888-992-8637. The Connecticut State Department of Social Services (DSS) administers the CFC Program.
The Connecticut Medicaid application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.