Advocates of the disabled and the elderly rallied at the Capitol rotunda this morning to urge the legislature to sign off on the Community First Choice Option (CFCO), the federal program that would allow individuals who qualify for institutional care under Medicaid to instead receive at-home or community-based services.

“The wonderful thing about the CFCO is it lets people stay at home while saving the state money … it’s a win-win,” said an advocate from AARP. The state Department of Human Services (DHS) has projected that the program would save the state over $300 million over the next 12 years, thanks to an improved federal match rate.


The CFCO would most immediately assist 3,000 families seeking a waiver for home/community-based services for their developmentally disabled children. Those folks are on a waiting list, with some waiting for over seven years for help (about 4,000 families now receive the waiver, but it’s maxed out under the current system). As parents came to speak at the podium today, many began by listing their current place in line on the 3,000-person list.

“The last I heard my son was somewhere in the 2000s,” said Jane Browning, who sits on the board of Disability Rights Arkansas, a nonprofit agency designated by the state to advocate for the disabled. Her son, 31, has Down syndrome and lives fairly independently in Arkadelphia with the help of family who assist in paying for his care. Many other families who aren’t so materially fortunate, are in more desperate need of the CFCO, she said. “All that’s standing in the way is the Arkansas state legislature, and we’re here to make sure that stops.”


This is true. Enacting the Community First Choice Option would not require passage of legislation — all it would take is a legislative committee giving DHS the green light to proceed with the program. Last fall, that review process was delayed by opponents of the CFCO, including conservative legislators who dislike the program because it’s a part of the Affordable Care Act.

But today, a couple of conservative legislators were on hand to express their support for the CFCO, including Rep. Josh Miller (R-Heber Springs), who’s been one of the House’s most vocal opponents of the private option expansion of Medicaid. Miller remained opposed to the private option throughout the current session even as many of his conservative colleagues broke ranks and voted to reauthorize the program


“I think there are some tweaks that need to be made to the CFCO program to better fit Arkansas, but I do believe it’s something that needs to be moved forward with,” Miller told me after today’s event.

He’s still opposed to the private option, but he doesn’t see that as a contradiction. Miller attracted much criticism last year when Max pointed out that Miller himself, who is in a wheelchair, has received substantial Medicaid assistance.

“The Arkansas legislature just voted to spend $2 billion last Thursday to insure two to three hundred thousand healthy, able-bodied adults … I think this should have been more of a priority and definitely should be more of a priority moving forward — to find a way to get these folks off the waiting list.”

What about his conservative colleagues in the legislature — such as Rep. Nate Bell (R-Mena), who’s led the charge against the CFCO in committee — opposed to extending another  federal entitlement under the Affordable Care Act?


“I find that humorous when they want to cry out and raise the conservative flag and fight Obamacare on this issue, when they didn’t have a problem ushering in the private option and other stuff that does take care of, for the most part, healthy, able-bodied adults,” Miller said. As for the CFCO, he continued, “you know, I don’t care if President Obama came up with it — I think it’s a good program.”

“Which he didn’t,” he added. “These waiver programs have been around since 1998, they’ve just been kind of renamed and rebundled in the Affordable Care Act, and this is a good part of that.”

Justin Nickels, a spokesperson for Disability Rights Arkansas, said that the goal of today’s rally was to keep the issue on the legislative agenda. The mood in the General Assembly seems more receptive this year than last year, he claimed. “A number of freshmen legislative have seen it and said that it seems to make sense,” he said. And the governor? “He’s looking into it.”

That remains to be seen. Even if hardline fiscal conservatives can be convinced or outvoted, the CFCO has other powerful interests working against it — not least the nursing home industry, which has quietly lobbied behind the scenes against the program.

Teresa Dodson, the Hot Springs mother I spoke to last fall for a cover story on the CFCO, was among those in attendance. She said she was also feeling hopeful about the legislature’s potential willingness to tackle the topic. In the meantime, though, she’s still laying the groundwork for her lawsuit against the state should the Community First Choice Option be rejected.