The Patient Protection and Affordable Care Act included Community First Choice (CFC), a new optional Medicaid home and community-based services (HCBS) state plan benefit which states could adopt. Through the CFC program, states can provide expanded home and community-based attendant services and supports to older adults and persons with disabilities. A benefit of CFC is that states receive a higher federal match rate than other HCBS programs. Thus far, eights states have adopted CFC. This comparative case study analysis examines state-level implementation of CFC to identify what facilitated implementation and what created challenges. The results suggest that consulting with the Centers for Medicare and Medicaid Services facilitated implementation while existing programs, insufficient engagement with stakeholders, aggressive timelines, and limited staff resources presented challenges. Based on these findings, states may want to consider how they approach implementing expansions or enhancements to HCBS benefits under the American Rescue Plan Act.

患者保护和平价医疗法案包括社区首选 (CFC)，这是一项新的可选医疗补助家庭和社区服务 (HCBS) 州计划福利，各州可以采用。通过 CFC 计划，各州可以为老年人和残疾人提供扩展的家庭和社区护理服务和支持。CFC 的一个好处是各州获得比其他 HCBS 计划更高的联邦匹配率。到目前为止，八个州已经采用了 CFC。此比较案例研究分析检查了 CFC 的州级实施情况，以确定促进实施的因素和造成挑战的因素。结果表明，咨询医疗保险和医疗补助服务中心有助于实施，而现有计划、与利益相关者的接触不足、紧迫的时间表、有限的人力资源带来了挑战。基于这些调查结果，各州可能需要考虑如何根据美国救援计划法案实施 HCBS 福利的扩展或增强。