Community First Choice Financial Feasibility and Program Design

The Innova Group helped the State of Colorado explore an opportunity to improve access to home attendant labor while tapping new permanent federal matching funds.  Specifically, their assignment was to evaluate the feasibility of adding personal attendant services to the State’s Medicaid benefit package under the Accountable Care Act’s “Community First Choice” program.

Colorado Medicaid historically has offered personal attendant services in its Home and Community Based Services (HCBS) waiver programs.  When the ACA offered increased federal funding for states who add this benefit to their core Medicaid programs, Colorado became interested in exploring its feasibility.

The Innova Group-led project helped the State define a robust but judicious benefit package, promote person‐centered care through client self‐direction of budget and attendant selection, and identify strategies to redirect $30 million in state funds through program conversion.

In assessing program feasibility, The Innova Group:

  • Developed a population‐specific caseload, utilization and substitution model, including scenarios and sensitivity analyses
  • Consulted with CMS on program interpretation, including eligibility for enhanced federal funds
  • Recommended a program benefits package, including federally‐mandated services as well as optional services
  • Recommended services to remain in Colorado’s 11 HCBS waivers
  • Modeled three alternative service delivery mechanisms, including agency‐based, self‐ directed, and hybrid models
  • Researched and recommended use of “person‐centered budgets,” which allow clients to control and manage their attendant budgets
  • Recommended a universal assessment approach for budget control and greater precision in client resource allocation
  • Studied the feasibility and economic impacts of waiving the state’s nurse practice act to enable the delivery of selected services by unskilled attendants
  • Assessed the feasibility of converting the state’s HCBS residential habilitation programs into the new program