Texas Medicaid Community First Choice (CFC): In-Home Personal Care and Homemaker Services

Last updated: March 04, 2024


Overview of Texas’ Community First Choice Medicaid Services

Texas’ Community First Choice (CFC) Services is a suite of long-term services and supports for seniors and persons with disabilities who require care equivalent to that which is provided in a nursing home. Intended to prevent and delay unnecessary nursing facility admissions, in-home 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 potential benefits include personal emergency response systems and habilitation services.

The services offered under CFC may be provided by licensed agency workers or program participants have the option to self-direct their personal assistance services. The Consumer Directed Services (CDS) option allows one to hire a friend or relative to provide them with care. Spouses, however, cannot be hired. 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. They cannot live in an assisted living residence or an adult foster care home.

Community First Choice Services is a Medicaid State Plan Option that was created by the Affordable Care Act (ACA). It is a 1915(k) State Plan Amendment. CFC Services are an entitlement; meeting the state’s Medicaid eligibility requirements guarantees one will receive benefits. This means there is never an interest list (waiting list) to receive CFC benefits.

 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.


Benefits of Texas’ Community First Choice Medicaid Services

The following long-term services and supports are available through CFC.

– Emergency Response Services – for persons who live alone
– Habilitation Services – assistance in developing, maintaining, and improving skills in completing daily living activities in order to live independently. May also include some personal care assistance.
– Personal Assistance Services (PAS) – includes assistance with daily living activities (i.e., bathing, dressing, mobility, eating, preparing meals), health-related tasks, light housecleaning, and escort services (accompanying to appointments / activities)
– Support Management – training on choosing, managing, and firing “attendants” (caregivers)


Eligibility Requirements for Texas’ Community First Choice Medicaid Services

CFC Services are available to Texas residents of all ages who are eligible for Texas Medicaid. Seniors can access CFC services via the Regular (traditional) State Plan Medicaid program or via the STAR+PLUS HCBS (Home and Community Based Services) Waiver program. The eligibility criteria below is relevant for persons accessing CFC via State Plan Medicaid. To access Texas’ State Plan Medicaid program, an applicant must be eligible for SSI (Supplemental Security Income).


Financial Criteria: Income, Assets & Home Ownership

In 2024, the individual applicant income limit is $943 / month, and the couple income limit is $1,415 / month (regardless of whether one or both spouses are applicants).

 There are other avenues through which Texas seniors might be financially eligible for Community First Choice Services. Persons enrolled in the STAR+PLUS HCBS Waiver may simultaneously receive services and supports via CFC. Persons who qualify for CFC via the Waiver program are allowed a higher monthly income than those who qualify via Regular State Plan Medicaid. Furthermore, a non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance and a Community Spouse Resource Allowance.

In 2024, the asset limit is $2,000 for a single applicant. For couples, the asset limit is $3,000 (regardless of whether one spouse or both are applicants).

Some assets are not counted towards the asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

While there is a 60-month Look-Back Rule in which Medicaid checks past asset transfers of those applying for Nursing Home Medicaid or home and community based services via a Medicaid Waiver, it is not relevant for Texas’ regular Medicaid program.

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Applicants for Texas’ Regular State Plan Medicaid program need not worry. For eligibility for this program, the home is exempt (non-countable) given the applicant (or their spouse) lives in it. Note that there are other Texas Medicaid programs, such as the STAR+PLUS HCBS Waiver and Nursing Home Medicaid that have a home equity interest limit in certain circumstances. Learn more here.


Medical Criteria: Functional Need

An applicant must require a Nursing Facility Level of Care (NFLOC) to be eligible for CFC services. To make this determination, a Medical Necessity and Level of Care (MN/LOC) Assessment is completed. One area of consideration is one’s ability / inability to independently complete the Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting, bathing). Relevant to some persons with Alzheimer’s disease or a related dementia, behavioral problems, such as wandering or removal of one’s clothes, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.

 Learn more about long-term care Medicaid in Texas.


Qualifying When Over the Limits

In Texas, for a senior to be eligible for Regular State Plan Medicaid, they must be eligible for SSI. Medicaid eligibility is automatically established when one is approved for SSI. While many Medicaid programs have alternative pathways to Medicaid eligibility, seniors applying for the State Plan Medicaid program do not have another option. Therefore, if over the income and / or asset limit(s) for SSI, Medicaid planning strategies to help persons who would otherwise be ineligible for Medicaid to become eligible is not feasible. However, TX has another Medicaid program that provides long-term care for persons who require a Nursing Home Level of Care and does not limit eligibility to persons enrolled in SSI.  Learn more about STAR+PLUS HCBS.


How to Apply for Texas’ Community First Choice Medicaid Services

Before You Apply

Persons must be eligible for Texas Medicaid in order to access Community First Choice services. To be eligible for State Plan Medicaid, seniors must be eligible for SSI. Approval for SSI benefits is automatic approval for Medicaid. This means one is sent a Medicaid benefit card when approved for SSI. To be clear, seniors do not apply for State Plan Medicaid via Texas Health and Human Services Commission. Persons can apply for SSI benefits (and hence, Medicaid benefits) via the Social Security Administration. Learn how to apply for SSI here. Once enrolled in SSI (and hence, Medicaid), persons can inquire about Community First Choice Services with the Medicaid agency. Persons already receiving SSI (and hence, Medicaid), should contact the Medicaid agency to inquire about CFC Services.

Learn more about Community First Choice here. The Texas Health and Human Services Commission (HHSC), an agency within Texas Health and Human Services (HHS), administers the program.


Approval Process & Timing

The SSI / Medicaid application process takes approximately 3 to 5 months. This includes the several weeks it generally takes one to complete the SSI application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process can be delayed even further.

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