The promise of self-direction/community living

In 2007 I participated in my first direct action and civil disobedience with ADAPT. (ADAPT is a national grassroots community […]

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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.

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). It was approved by the 2013 Minnesota Legislature.

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.

When CFSS is implemented later this year:

• 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.

• People receiving services will develop their own person-centered service delivery plan, with assistance as needed.

• People may choose to use the money that is allocated for their services to purchase items that will increase their independence.

• Support workers will be allowed to help people learn to be more independent, instead of simply doing things for the person they support.

• 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.

• People will have the choice to employ their own support workers, with assistance from a financial management service.

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.


Galen Smith is involved with ADAPT and the ServicesEmployees International Union (SEIU) although he has submitted these comments as an individual. He is also a member of the CFSS Implementation and Development Council.


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