Community First Choice Financial Feasibility and Program Design

Colorado Medicaid historically has offered personal attendant services only in its Home and Community Based Services waiver (HCBS) programs.  When the Accountable Care Act offered increased federal funding to states that added this benefit to their core Medicaid programs, Colorado became interested in exploring its feasibility.

The Innova Group led project defined a robust, but judicious benefit package, promoted person‐centered care through client self‐direction of budget and attendant selection, and identified strategies to enable the state to save over $30 million in state funds through program conversion.

In this process of assessing whether the new federal program, “Community First Choice” (CFC), could be implemented with budget neutrality, 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