The new Community First Services and Supports (CFSS) Program is to start April 1. It is a statewide assistance and support program for people with disabilities, the elderly and others with special health care needs. It is part of the Minnesota Department of Human Service’s’ (DHS) 2020 Program. DHS has been working to implement CFFS, which restructures the existing Personal Care Assistance (PCA) program. CFSS has drawn a mixed reaction.
Below are two viewpoints, pro and con.
PRO: The promise of self-direction/community living
by Galen Smith
In 2007 I participated in my first direct action and civil disobedience with ADAPT. (ADAPT is a national grassroots community that organizes disability rights activists to assure the civil and human rights of people with disabilities.) I joined hundreds of other activists with disabilities in shutting down the offices of the American Medical Association (AMA) in Chicago. We were there to exercise our collective power and demand that the leaders of the AMA to join us in publicly urging Congress to pass the Community First Choice Act.
CON: Limitations, timeline issues are potential problems
by Chris Bell
Here are some of the major problems with the DHS proposal to switch from the PCA program to CFSS:
“Stuff happens” to everyone, but the unexpected calamity frequently falls most heavily on people with disabilities. To enable a person to move into a more integrated community than the one he or she left, or to enable a person to remain at home and in such a community even when disaster strikes requires a backup inter-disciplinary team which is available 24 hours a day, seven days a week, and is flexible enough to timely and effectively respond to an individual’s emergency situation. Enabling the person to remain home is the best outcome. If a person must leave home for treatment, the second-best outcome would be to do what is required to allow the person to come back to his home and community after treatment. These rapid response teams exist in many states, but Minnesota’s emergency reaction program is only limited to persons with mental illness.
PRO (Galen Smith):
The Community First Choice Act didn’t make it through Congress but in 2010 the Community First Choice Option was included in the Affordable Care Act. The option isn’t quite the mandate we were hoping for but it is a step in the right direction toward home- and community-based services. The option offers additional funding to states that provide consumer-directed home and community-based services to people who qualify for Medicaid funded long-term care in an institution. In 2012 Minnesota was one of the first states to take the federal government up on their offer by creating its own version of the Community First Choice Option called Community First Services and Supports (CFSS). The 2013 Minnesota Legislature approved it. As a part of the CFSS Implementation and Development Council, I have had the opportunity to give input on the design of this new program. It will soon replace the Personal Care Assistance (PCA) program. The work of implementing policy change isn’t quite as exciting as fighting for it out on the streets, but it’s no less important. My work on the council has been engaging, challenging and sometimes infuriating. But after nearly 1½ years, we are very close to seeing a new program that will bring real benefits to people with disabilities in Minnesota.
CON (Chris Bell):
Unfortunately DHS’ state plan amendment completely lacks such supports and services for people with other disabilities which are necessary if home- and community-based living is to be a reality for many people. This failure will inevitably result in loss of housing and re-institutionalization or homelessness for many people with disabilities.
• Everyone who is currently eligible for PCA services will be eligible for CFSS services.
• People who currently receive only 30 minutes of PCA services per day will be eligible for at least 75 minutes per day.
• Everyone receiving CFSS services will have the right to play a significant role in choosing their own support workers.
• Parents, step-parents and legal guardians will be able to work as paid support workers for their minor children.
• People may choose to have their spouse work as their paid support worker.
• People who receive CFSS services will be allowed to work as a support worker for another CFSS recipient.
The DHS proposal limits personal assistance to 275 hours per calendar month. Paid family members, likewise, are not allowed to work more than 40 hours a week. An exception to these restrictive limitations should be allowed when a crisis or emergency may require the aid of personal assistance beyond what is permitted.
• People receiving services will develop their own person-centered service delivery plan, with assistance as needed.
• Support workers will be allowed to help people learn to be more independent, instead of simply doing things for the person they support.
A person needs hands-on assistance or constant supervision and cueing in order to be eligible for CFSS. This highly restrictive service definition particularly penalizes persons with mental and cognitive disabilities, including mental illnesses, developmental disabilities and brain injuries, who require assistance with supervision and/or cueing, but who do not need constant supervision to do so.
• People may choose to use the money that is allocated for their services to purchase items that will increase their independence.
• People will have the choice to employ their own support workers, with assistance from a financial management service.
The CFSS proposal may be interpreted to exclude paying for Internet access. The proposal should be revised to make clear that payment for Internet access is available under CFSS.
Even with all of these potential benefits, there are still many questions about how CFSS will be implemented. The comment period ended February 12. Nonetheless, it is crucial that everyone involved with the PCA program to stay engaged with the transition to CFSS, especially people who receive services.
DHS claims that its state plan amendment should take effect on April 1, 2014. This self-imposed deadline cannot be met if the CFSS program is to get off to a good start. MnChoices is a tool to be used to assess eligibility, as well as an individual’s abilities and limitations and their desires and goals although this program is not specifically mentions. MnChoices will not be rolled out to all of the counties until June 2014 under the existing DHS timeline, assuming there are no more delays. Under an April 1 effective date, persons with disabilities will be assessed or reassessed by a variety of different tools until MnChoices is fully implemented. One concern is that assessment of individuals with disabilities between April 1 and June 2014 may lead to different and inferior CFSS services. Whether or not this result would violate Medicaid nondiscrimination law or the ADA, it is poor policy. It is hard to see what harm would be if the start of CFSS was delayed until MnChoices is implemented in all 87 counties. The inadequacies of the current draft amendment maybe inconsistent with the state’s Olmstead Plan and this question cannot be answered without a thorough review of both the Olmstead Plan and the CFSS proposal.