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Community First Choice is a Medicaid state plan option authorized under Section 1915(k) of the Social Security Act (added by the Affordable Care Act in 2010) that provides community-based attendant services and supports to Medicaid-eligible individuals who need an institutional level of care. Unlike HCBS waivers, CFC is an entitlement — states that elect CFC cannot cap enrollment or maintain waitlists. CFC covers personal assistance services, supports for activities of daily living (bathing, dressing, eating, mobility) and instrumental activities (meal preparation, medication management, community access), backup systems, and voluntary training for workers selected by the individual. States receive a 6% increase in federal Medicaid matching funds for CFC services, creating a strong financial incentive.
CFC is a waitlist-free alternative to HCBS waivers for personal care services. Not all states have adopted CFC, but those that have provide guaranteed access to attendant services. The Atlas identifies which states offer CFC.