New ACA Provision Big Step toward Keeping People with Disabilities Out of Nursing Homes

By Mike Ervin, Abilities Expo Ambassador

It's a good bet that most people with disabilities who need assistance from others to live their lives each day would very much prefer to receive that assistance in their homes rather than in a nursing home. A little-known but significant provision of the Affordable Care Act is designed to make it much easier for that to happen.

Disabled elderly man happy living at home.

Section 2401 of the ACA creates the Community First Choice Option. The CFCO gives state governments a strong incentive design and implements programs that help people with disabilities stay out of nursing homes and other institutions. State governments and the federal government split the cost of providing services under Medicaid 50/50. But states that choose the CFCO receive an extra 6 percent in federal Medicaid reimbursement. That's several million dollars in extra state revenue.

But federal funds under CFCO can only be used for programs that support people with disabilities living outside institutional settings. The assistance received through these programs must be, as stated in the law, "controlled, to the maximum extent possible, by the individual" receiving the assistance. In other words, the goal is to make it more possible for people with disabilities who need help with activities of daily living to hire and direct whomever they want to help them in their homes.

CFCO funds may also be used to help people transition out of nursing homes by paying for ''expenditures for transition costs such as rent and utility deposits, first month's rent and utilities, bedding, basic kitchen supplies, and other necessities…" the law states. This is important because most nursing home residents have no money or possessions, so just covering cost associated with moving into a new home can be an insurmountable obstacle to leaving the nursing home.

So far only eight states have chosen to exercise the CFCO. They are New York, Texas, Maryland, Arizona, Arkansas, Minnesota, Oregon and California.

Living at home under the ACA.

The CFCO came about as the result of intense activism by the disability rights organization ADAPT. ADAPT's ultimate political goal is to revolutionize the human services delivery system so that no one is forced to enter a nursing home just to receive assistance with daily living. The CFCO is a big step in that direction.

ADAPT activists assert political pressure using tactics of non-violent civil disobedience that often lead to arrest. ADAPT activists have occupied the offices of legislators and policymakers. They've disrupted meetings and political gatherings. They've organized marches and rallies. After many years of doing this in Washington D.C and other cities, ADAPT built such political power that the CFCO was included in the ACA in response to the group's demands.

It will take even more local activism for the CFCO to live up to its full potential. In states that are taking advantage of this new source of revenue, it's important for people with disabilities to be seriously involved in the implementation process. The law says state plans for using CFCO funds are required to be developed "in collaboration with a Development and Implementation Council established by the State that includes a majority of members with disabilities, elderly individuals, and their representatives…" Serving as a member of this council or as a watchdog over its members is an effective way to help.

In the many states that have not yet opted in to the CFCO, it's important for those who want to stay out of nursing homes and institutions to organize and push their governors to do so. Do the leaders of the local centers for independent living and other entities that serve and advocate for people with disabilities know about CFCO? Is it a top priority? If not, push them to push the state government to sign up for the CFCO.

For more information on the CFCO contact ADAPT of Texas at Address: 1640-A; E. 2nd ST. STE 100; Austin, TX 78702. Phone: 512-442-0252. Email:

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