Connecticut weighs ending CFC option

Connecticut families and disability advocates are reacting to Governor Ned Lamont’s budget proposal to close the state’s Community First Choice (CFC) option and transfer more than 7,000 participants into one of Connecticut’s capped Medicaid waivers. At the center of the debate is how a shift from an entitlement-style benefit to capped waivers could reshape access to home and community-based services, and what that could mean for people who rely on consistent supports to stay in the community.

What the proposal would change

CFC functions as a broad, entitlement-style Medicaid benefit, while waivers typically limit how many people can be served. Families and advocates raised concerns that moving participants into capped waivers could worsen capacity constraints, deepen eligibility silos, and expand waiting lists. The core fear is that when community supports are unavailable, more restrictive program structures could increase the risk of people remaining in, or being pushed toward, institutional care.

In addition to access concerns, stakeholders pointed to operational friction in the current system, including fiscal intermediary and payroll issues. They argued those problems should be addressed directly rather than resolved by eliminating the option entirely.

Budget rationale and cost growth

Reporting on the proposal highlights rapid growth in program costs as a key budget rationale. State officials cited an increase from $88.8M in 2018 to $371M in 2025. The administration framed “sunsetting” the CFC option as a pathway to savings by fiscal year 2029, positioning the change as part of broader budget decision-making under financial pressure.

Why CFC structure matters to HCBS and IDD

CFC is a federal Medicaid state plan option that allows states to provide home and community-based attendant services and supports. CMS notes the option was created under the Affordable Care Act. It is also paired with a 6 percentage-point FMAP increase for qualifying services, which can materially affect how funding flows through a state’s Medicaid system.

From a provider operations standpoint, ending CFC can shift three fundamentals at once:

• Who is eligible for services

• How many people can be served, since waivers are capped

• How funding routes into the state’s delivery system

Even for IDD agencies outside Connecticut, the proposal is a high-signal example of a state exploring how to “rebalance” long-term services and supports (LTSS) spending under budget pressure by moving away from broader state plan options toward narrower, capped program structures.