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Developing the Community First Choice Program in New York

  • By: NYSHealth
  • Date: March 2017
  • Priority Area: Special Projects Fund
  • Type: Grant Outcome Reports
  • Category: Grant Outcome Report
  • Grantee Name: New York Association on Independent Living


In March 2011, New York State made an express commitment to implement the Community First Choice (CFC) an option under the Affordable Care Act that offers states enhanced Medicaid matching funds to enable people who would be eligible for institutional level of care to stay in their homes and get services in the community. This option was a win for both the State and its most vulnerable residents, with the potential to expand access to community-based services for approximately 1 million New York Medicaid recipients, generate an estimated $90 million a year in net Medicaid savings to the State, and rebalance incentives away from institutional care settings. NYSHealth awarded New York Association on Independent Living (NYAIL), in partnership with the Center for Disability Rights (CDR), a grant to work with the State on developing and adopting the CFC program in New York.

Grantee: Rapid Results Institute, Inc.

Dates: March 2015 – December 2015

Grant Amount: $73,513

Grantee Website:

Grant ID:  15-03317

Outcomes and Lessons Learned: Running into Legislative Roadblocks

Under the original scope of this grant, NYAIL and CDR planned to advise and provide technical assistance to the State and other stakeholders on developing the CFC program, as well as produce real-time analysis about its implementation and actionable recommendations to improve the program. NYAIL would also identify barriers and successes encountered by the State, health plans, and key providers in the delivery of CFC-covered services. After the adoption of CFC in New York, both organizations planned to educate health plans about effective implementation and how to ensure plan networks included the right community-based providers. Finally, NYAIL and CDR would work with independent living centers throughout the State to inform providers, consumer advocates, and potential beneficiaries about this new option.

However, the project was delayed, primarily because of a statutory change that would be needed to obtain the federal approval needed for CFC implementation in New York State. The timing of political support became an obstacle. In 2014, while the State Senate supported passage of the amendment, the Assembly did not. By early 2015, the tables had turned—the State Assembly was in favor of the amendment, but the Senate no longer supported it.

Although the legislative delay put on hold NYAIL’s implementation work, it achieved the following outcomes:

  • Supported the State’s development of its CFC model, provided technical assistance and consult, and participated in workgroups advising the State; and
  • Assisted the State with its federal application for a Medicaid State Plan Amendment to include the CFC option.

After a one-year extension—with the adoption of the CFC option still in limbo—NYSHealth’s grant to NYAIL closed in September 2015. Since that time, New York State did get inclusion of the CFC option into the Medicaid State Plan Amendment that was approved by the federal government in October 2015. In June 2016, the State resolved the barriers to implementation. As a result, New York is now one of six states participating in the CFC option. NYAIL and CDR have continued their efforts to ensure that implementation of CFC results in the most expansive increase of access to home- and community-based services for New Yorkers with disabilities.

Co-Funding and Additional Funds Leveraged: N/A.