CT Home Care Advocates Fear Cuts to Community First Choice

Families of disabled Connecticut residents packed the Legislative Office Building earlier this month to protest Governor Ned Lamont’s proposal to eliminate Community First Choice, the state program that allows people who need nursing-home-level care to receive that care at home instead. Advocates are calling the potential cuts cruel and warning that thousands of vulnerable residents could end up on lengthy waiting lists or lose access to care entirely.

Community First Choice operates without an enrollment cap. Any Connecticut resident who qualifies for Medicaid and requires nursing-home-level care can choose to enroll. Advocates say that flexibility is precisely the point. The program allows participants to stay with their families rather than enter institutional settings, and researchers have consistently found that home and community-based care costs less than nursing home placement.

The Lamont administration’s argument is straightforward: the program worked better on paper than in practice. Officials say they believed the program’s structure, combined with federal reimbursement dollars, would generate net savings for the state. Instead, rapid enrollment growth has pushed costs beyond what the budget can absorb. The administration wants to replace Community First Choice with a waiver program that caps enrollment, similar to the structure used by other state home care programs.

That cap is exactly what alarms advocates and families. Connecticut currently serves around 7,000 people through Community First Choice. If the state moves to a capped waiver program, anyone who can’t secure a spot would face waiting lists. Given the trajectory of enrollment growth, the fear is that those waiting lists could stretch for months or years, leaving people who require significant daily assistance without adequate support.

The stakes become clearer when you look at where long-term care sits in the state budget. Roughly 40 percent of Connecticut’s Medicaid spending goes toward long-term care, covering both institutional placements and home-based services. That figure explains why the administration feels it cannot ignore the cost trajectory. It also explains why advocates are watching this budget cycle with particular urgency. A program that helps people avoid nursing homes does double duty: it serves participants’ preferences and, in theory, controls costs. Critics of the proposal argue the administration is dismantling something that actually works.

What the Lamont administration says it wants to do with the savings from capping Community First Choice is redirect resources toward other home and community-based programs that are currently underfunded. Some disability advocates are skeptical. They have seen budget promises to one population get diverted before, and they argue that adding a cap to the most flexible program in the state’s portfolio won’t fix the underlying pressure on long-term care funding. It will simply create a new class of people who qualify for help but can’t access it.

Connecticut is also navigating this decision against a backdrop of federal uncertainty. Medicaid is under pressure in Washington, and any reduction in federal matching funds would amplify whatever choices Hartford makes. Families who showed up at the Legislative Office Building understand that dynamic, even if they don’t have detailed budget projections in front of them. What they have is direct experience with what it takes to care for a family member with significant disabilities outside of an institution.

The legislature will have the final say on whatever Lamont proposes. Budget negotiations typically stretch into late spring, and this issue is likely to generate sustained lobbying from disability rights organizations, home care workers, and family caregivers. The question Hartford has to answer is whether capping access to a program that keeps people out of nursing homes actually saves money in the long run, or whether it shifts costs around without reducing them.

For the roughly 7,000 people currently enrolled, the answer matters immediately. For the families who turned out to protest, the framing as a budget efficiency question misses something basic: the program gives people with significant disabilities the ability to live at home. That, they argue, should not be treated as an optional expenditure.