The Community First Choice Option (CFC) is an optional state plan amendment made possible by the Patient Protection and Affordable Care Act. CFC is a Medicaid program that incentivizes the provision of long term services and supports (LTSS) in the community, as opposed to nursing facilities, institutions, intermediate care facilities, and large group homes. CFC has the potential to fundamentally reform the state’s Medicaid LTSS to more effectively serve a complex cross-disability, cross-age population. CFC will be implemented within the context of Medicaid Redesign Team (MRT) and other care management initiatives currently underway. CFC was created to assist State’s in meeting their obligations under the decision of the United States Supreme Court in Olmstead v. L.C., 527 U.S. 581 (1999), which ruled that states must provide services and supports in the most integrated setting possible.