MassHealth Fact Sheet – FY10 H.1 
Community First Initiatives

Overview 

The Administration’s long-term care policy is Community First, a commitment to ensuring that 
elders and people with disabilities have access to community-living opportunities and supports 
that address each individual’s diverse needs, abilities and backgrounds. Demographic projections 
regarding expanding numbers of residents likely to be in need of long-term supports highlight the 
importance of this policy commitment. 

MassHealth is embarking upon several initiatives to provide members with more choices for 
community-based services.  In addition to beginning implementation of the Community First 1115 
Demonstration waiver, MassHealth will implement a cash and counseling program for certain 
long-term care benefits to purchase their own community supports.  Settlement of the Rolland v. 
Romney case will expand community care options for individuals with mental retardation and 
developmental disabilities, and settlement of the Hutchinson v. Romney case will expand 
important community alternatives for brain-injured adults and seniors. 

FY 10 Policy Initiatives

Community First 1115 Demonstration - $21M Investment
H.1 includes $21M to begin offering new services under the new Community First (CF) 1115 
waiver in FY10 (pending CMS approval).  Implementation of the new program is targeted to first 
reach those members who do not currently have access to home- and community-based services 
and also to expand services modestly for a small group of people with some home- and 
community-based services now.
*	Members currently enrolled in the Traumatic Brain Injury (TBI) 1915(c) waiver, administered 
by the Massachusetts Rehabilitation Commission, will immediately be offered enrollment in 
the CF Waiver for access to expanded home and community based services, including 
behavioral health services. The TBI waiver will be discontinued once the Community First 
Waiver is implemented.
*	CF Waiver transition capacity will also be opened for 500 MassHealth members with 
disabilities under age 60 who are residing in nursing facilities. These members will have 
access to case management and transition services to help them move from nursing facilities 
into the community. MassHealth will also open enrollment to individuals with disabilities under 
age 60 who are living in the community and who meet a nursing facility or specialty hospital 
level of care.  These members will have access for the first time to the expanded array of 
services available under the CF Waiver.  
*	Individuals over the age of  60 who need a nursing facility level of care will continue to have 
access to home and community based services, including transition services, through the 
Frail Elder 1915(c) waiver, and an anticipated waiver amendment will include additional 
services in FY10.
*	In FY11, individuals aged 60+, including members in the Frail Elder 1915(c) waiver, will begin 
enrollment in the more expansive CF Waiver.  

Cash and Counseling Initiative 
H.1 permits MassHealth to implement a “cash and counseling” program to allow interested 
consumers the flexibility to get a cash budget. The consumer may use the budget to make 
arrangements for their care that best fits their circumstances, needs, and preferences.