Community First Choice (CFC) in Connecticut: Self-Directed Home Care

Connecticut's Community First Choice (CFC) program gives Medicaid members direct control over their personal care — including the ability to hire, train, and manage their own attendants. For families caring for a parent with dementia, CFC is one of the few programs that puts budgetary and employer authority in the hands of the participant (or their representative), rather than routing everything through an agency.

What CFC Covers

CFC is a Medicaid state plan benefit, not a waiver. The program covers personal care assistant (PCA) services for hands-on help with activities of daily living, assistive technology and adaptive equipment, home modifications for accessibility and safety, and skills training for both the participant and their hired attendants.

For a parent with dementia, CFC-funded services can include help with bathing, dressing, toileting, transferring, eating, and medication reminders. The program can also fund home modifications like grab bars, ramps, and door alarm systems — the same types of safety modifications that dementia caregivers need to keep a parent safe at home.

Who Qualifies

CFC is available to active HUSKY A, HUSKY C, or HUSKY D Medicaid members who meet an institutional level of care. This means the person must have functional limitations significant enough that they would otherwise require care in a nursing facility. A clinical assessment determines this — the same type of assessment used for CHCPE eligibility screening.

The financial eligibility is tied to Medicaid enrollment. For HUSKY C (the primary long-term care Medicaid program), the countable asset limit is $1,600, and income must fall below the medically needy threshold or the applicant must complete a spend-down. If your parent already has active Medicaid coverage, CFC eligibility is about the functional assessment, not additional financial hoops.

The Self-Direction Model

What makes CFC different from other Connecticut home care programs is the self-direction component. The participant — or their authorized representative — acts as the employer of record for their personal care attendants. This means you choose who provides the care. You can hire family members, friends, or community members as paid PCAs. You set the schedules that work for your family's routine. You manage training specific to your parent's cognitive and behavioral needs. You have budget authority over how allocated hours are used.

This flexibility is particularly valuable for dementia care because it allows hiring someone who already knows your parent and can manage their specific triggers, routines, and communication needs — rather than rotating agency staff who may not understand dementia behavior patterns.

Restrictions on Who You Can Hire

Connecticut places strict limits on certain relationships. State regulations prohibit hiring a spouse as the paid PCA. The appointed Health Care Representative cannot be hired as the PCA. The appointed conservator cannot be hired as the PCA.

Certain family members can be hired as PCAs under CFC, provided they are not also serving in one of the prohibited roles above. This makes CFC one of the few programs in Connecticut that allows getting paid to care for a family member with Medicaid coverage.

The Processing Backlog

The practical challenge with CFC is the processing timeline. Applications currently take four to six months or longer to process through the Department of Social Services. This backlog means CFC is not a crisis solution — it requires advance planning.

If your parent will likely need ongoing home care and you want the self-direction option, start the CFC application process at the same time you apply for CHCPE or HUSKY C coverage. The CHCPE program can provide agency-based home care services while the CFC application is pending, ensuring there is no gap in care during the wait.

How CFC Interacts with CHCPE

CFC and CHCPE are not mutually exclusive. A person can receive CFC self-directed PCA services alongside CHCPE-authorized services like adult day health, homemaker visits, or care coordination. The key is that the service plans do not duplicate — the CHCPE care manager and the CFC support broker coordinate to ensure each program covers different needs.

For families managing dementia care at home, a common combination is CHCPE-funded adult day care during daytime hours plus CFC-funded self-directed PCA services for evening and weekend support, covering the gaps that adult day programs do not.

The Connecticut Dementia Care Guide walks through the CFC application process alongside CHCPE eligibility screening, including the forms, timelines, and coordination strategies for combining multiple programs into one care plan.

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