Community First Choice (CFC) in Texas: Medicaid Attendant Care Explained

If you’ve been researching Medicaid home care in Texas, you’ve probably encountered STAR+PLUS and Consumer Directed Services. But there’s another program that many Dallas families use alongside STAR+PLUS without even knowing its name: Community First Choice (CFC).

CFC is a Medicaid state-plan benefit — not a waiver — that provides attendant care services to individuals who meet an institutional level of care. It’s often paired with STAR+PLUS HCBS, and the two work together to create a more complete care package.

What CFC Covers

CFC provides personal attendant services: help with bathing, dressing, grooming, toileting,eating, mobility, and other activities of daily living. It also covers habilitation — support foracquiring, maintaining, and improving daily living skills.

The services overlap significantly with what STAR+PLUS HCBS covers. In practice, CFC mayfund the attendant care hours while STAR+PLUS HCBS funds additional services like adaptiveaids, emergency response, and respite. The two programs complement each other under a singlemanaged care plan.

How CFC Connects to STAR+PLUS

CFC isn’t a separate enrollment. If your loved one is enrolled in STAR+PLUS and meets the institutional level of care, CFC services are incorporated into their care plan by the MCO. The service coordinator manages both CFC and HCBS services together — the family doesn’t need to apply separately or navigate a separate system.

In our experience at CareChoice, many Dallas families are already receiving CFC-funded serviceswithout knowing it. The MCO bundles everything under the STAR+PLUS umbrella, and thespecific funding source (CFC vs. HCBS waiver) is transparent to the family. What matters to yourfamily is the total package of services authorized and the hours approved — not which budget linefunds each component.

CFC and Consumer Directed Services

CFC attendant care can be delivered through the CDS model. This means a family member can serve as the paid attendant for CFC-funded services, subject to the same rules that apply to CDS: the employer and attendant must be different people, spouses cannot be paid, and an FMSA handles payroll.

For families already enrolled in STAR+PLUS CDS, CFC may increase the total authorized attendant hours or funding available — all managed through the same CDS arrangement.

Why CFC Matters

CFC matters for two practical reasons. First, as a state-plan benefit rather than a waiver, CFC doesn’t have a waitlist. If your loved one meets the eligibility criteria, CFC services are available.  Second, CFC can provide attendant hours on top of what STAR+PLUS HCBS authorizes, potentially increasing the total care your loved one receives.

In our experience, families who work with CareChoice to ensure their care plan captures all available funding sources — CFC, HCBS, and any other applicable programs — end up with more comprehensive coverage than families who only pursue one pathway.

Contact CareChoice →Dallas team

Written by Sophia Aloia, Content & SEO Manager | CareChoice