Special Projects Fund

Grantee Name

New York Association on Independent Living

Funding Area

Special Projects Fund

Publication Date

March 2017

Grant Amount


Grant Date:

September 2012 – September 2014

New York State chose to implement the Community First Choice (CFC) program, an option under the Affordable Care Act that offers states enhanced Medicaid matching funds to enable people who would be eligible for institutional levels of care to instead stay in their homes and get services in their communities.

CFC offered many potential advantages: it could expand access to community-based services for approximately 1 million New York State Medicaid recipients, generate an estimated $90 million a year in net Medicaid savings to the State, and rebalance incentives away from institutional care settings.

NYHealth awarded New York Association on Independent Living (NYAIL), in partnership with the Center for Disability Rights (CDR), a grant to work with the State on developing and adopting the CFC program in New York State.

Outcomes and Lessons Learned

Originally, NYAIL and CDR planned to advise and provide technical assistance to the State and other stakeholders on developing the CFC program, as well as produce real-time analysis about its implementation and actionable recommendations to improve the program. Both organizations planned to educate health plans about effective implementation and how to ensure plan networks included the right community-based providers. NYAIL and CDR would also work with independent living centers throughout the State to inform providers, consumer advocates, and potential beneficiaries about this new option. Finally, NYAIL would identify barriers and successes encountered by the State, health plans, and key providers in the delivery of CFC-covered services.

The project was significantly delayed, however, once it became clear that a statutory change would be needed to obtain the necessary federal approval for CFC implementation in New York State. The timing of political support became an obstacle. In 2014, the State Senate supported passage of the amendment but the Assembly did not. By 2015, the tables had turned—the State Assembly was in favor of the amendment but the Senate no longer supported it.

Although the legislative delay put on hold NYAIL’s implementation work, it achieved the following outcomes:

  • Supported the State’s development of its CFC model, provided technical assistance and consultation, and participated in workgroups advising the State; and
  • Assisted the State with its federal application for a Medicaid State Plan Amendment to include the CFC option.

After granting an extension—with the adoption of the CFC program still in limbo—NYHealth’s grant to NYAIL closed. Since then, New York State did succeed in having the CFC option included in the Medicaid State Plan Amendment that was approved by the federal government. The State subsequently resolved the remaining barriers to implementation. As a result, New York is now one of six states participating in the CFC program.

NYAIL and CDR have continued their efforts to ensure that implementation of CFC results in increased access to home- and community-based services for New Yorkers with disabilities. The current focus for advocates, including NYAIL, is to ensure that eligible New Yorkers are getting the services they need to be able to stay in their homes and for New York State to transform its long-term services and supports system into one that conforms with the law and other leading states. As of now, the State has given itself until April 2018 for implementation of those changes.

Co-Funding and Additional Funds Leveraged: NYAIL’s work has already contributed to an estimated $300 million a year in enhanced federal funding to the State since CFC was approved in 2015.