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Current Environment

Although CFC was optional, it was believed that the six percent additional FMAP would result in states selecting the option and providing a real alternative to institutionalization. Unfortunately, only six states (California, Oregon, Maryland, Montana, New York and Texas) have implemented Community First Choice. Other states have indicated that they intend to implement CFC or have submitted a State Plan Amendment to CMS, but uptake of this option has been extremely limited. Some states – like Illinois – determined the state would actually generate excess long term revenue by implementing CFC, but still haven’t selected the option. It is possible for states to implement CFC, secure the extra federal funds, and continue to maintain policies that limit access to services or fail to provide a real alternative to institutionalization.