What is CFSS? Community First Services and Supports (CFSS) is Minnesota's Medical Assistance program that pays a support worker to help a person with a disability or an older adult with daily living tasks so the person can stay in their own home. It is governed by Minn. Stat. § 256B.85, launched on October 1, 2024, and is replacing the Personal Care Assistance (PCA) program and the Consumer Support Grant (CSG).
The statute describes CFSS as "a participant-controlled method of selecting and providing services and supports." The person receiving services (the participant) chooses how much control to take: an agency model in which a provider agency employs the worker, or a budget model in which the participant is the employer and a financial management services (FMS) provider handles the paperwork.
This guide explains CFSS for families, workers, and agency staff: what it replaced, the two models, who is eligible and who does the assessment, what services are covered, who can be a support worker, how the amount of service is set, the timeline through September 30, 2027, and where agencies fit. It reflects the statute and Minnesota Department of Human Services (DHS) guidance as of September 2026.
What CFSS replaced: PCA and the Consumer Support Grant
Minnesota's PCA program, under § 256B.0659, paid agencies to send personal care assistants into homes. The Consumer Support Grant gave some families a cash grant to arrange their own care. CFSS folds both into one program with two ways to use it. DHS began moving people to CFSS on October 1, 2024, and every remaining PCA and CSG participant must be transitioned by September 30, 2027, usually at their annual reassessment.
The core service is the same. Both PCA and CFSS pay for hands-on help, or constant supervision and cueing, to accomplish activities of daily living (ADLs) such as dressing, bathing, eating, transfers, mobility, positioning, and toileting; instrumental activities of daily living (IADLs) such as meal preparation, shopping, laundry, and managing medications; and health-related procedures and tasks that a licensed professional can teach or assign. What changed is who can control the service, what else the authorization can pay for, and the rules that agencies and workers must follow. The PCA to CFSS transition guide covers the agency side of that change in detail.
The two CFSS models
Every participant picks a model. The statute defines the agency-provider model as services delivered "through the agency's own employees" while the participant keeps "a significant role in the selection and dismissal of support workers." The budget model "allows the use of a service budget and assistance from a financial management services (FMS) provider for a participant to directly employ support workers and purchase supports and goods."
| Topic | Agency model | Budget model |
|---|---|---|
| Who employs the worker | The CFSS provider agency | The participant (or the participant's representative) |
| What the lead agency authorizes | Units of service (one unit is 15 minutes) | A dollar budget |
| Who runs payroll and taxes | The agency | The FMS provider, on the participant's behalf |
| Who checks worker competency | The agency, by direct observation within 30 days (§ 256B.85, subd. 11b) | The participant, by evaluation within 30 days (subd. 14) |
| Consultation services | Available; check the current DHS manual for when required | Required (subd. 13) |
| Union coverage | Not covered by the SEIU contract | Covered by the SEIU contract |
A participant can move between models by updating the service delivery plan with a consultation services provider and getting lead agency approval. One rule to know: under subd. 13, a participant who leaves the budget model during a service plan year cannot return to it until the next plan year. The agency model vs budget model comparison walks through the trade-offs for participants and agencies.
Who is eligible for CFSS and who does the assessment
Eligibility is set in § 256B.85, subd. 3. A person qualifies for CFSS if they meet one of four program tests and one functional test.
Program tests (any one): eligible for Medical Assistance (with a few exceptions listed in the statute); a participant in the Alternative Care program; a participant on a home and community-based waiver under chapter 256S or §§ 256B.092, 256B.093, or 256B.49; or a child with medical services identified in an individualized education program.
Functional test: the person must "require assistance and be determined dependent in one activity of daily living or Level I behavior" based on an assessment under § 256B.0911. Level I behavior means physical aggression toward self or others, or destruction of property, that requires the immediate response of another person. A person on a family support grant is not eligible.
The assessment is done by a certified assessor at the lead agency, which is the county, Tribal nation, or managed care organization responsible for the person. Under subd. 5 the assessment must be conducted face-to-face, initially and at least annually, or when the person's condition or needs change, using the MnCHOICES format DHS sets. The lead agency's assessor must communicate the results and any authorization in writing within ten business days, along with the participant's right to appeal.
Compliance note: the lead agency assessor, not the provider agency, decides eligibility and the amount of service. § 256B.85, subd. 9 lists "assessments by CFSS provider organizations or by independently enrolled registered nurses" among the services CFSS does not cover. An agency can help a family request an assessment, but it cannot perform one.
What CFSS services can include
Subd. 7 lists the covered services. In plain terms, a CFSS authorization can pay for:
| Covered service | What it means |
|---|---|
| Assistance with ADLs, IADLs, and health-related procedures and tasks | Hands-on help or constant supervision and cueing to complete the task |
| Skill building | Help acquiring, maintaining, and enhancing the skills to do those tasks |
| Goods, items, and environmental modifications | Purchases that increase independence or substitute for human assistance, bought through an FMS provider |
| Observation and redirection | Monitoring and redirecting behavior or symptoms where there is an assessed need |
| Back-up systems | Pagers or other devices to ensure continuity of services |
| Swimming lessons | For a participant younger than 12 whose disability raises the risk of drowning |
| Consultation services | Help choosing a model and writing the person-centered service delivery plan |
| FMS provider services | Payroll, taxes, background studies, and spending reports in the budget model |
| Services by parents, stepparents, legal guardians of minors, and spouses | Allowed within the weekly hour limits in subd. 7b |
| Worker training and development | Training, observation, and coaching of the participant's support workers (subd. 18a) |
Subd. 9 lists what CFSS does not cover, including services that duplicate other funding, room and board, medications and medical supplies, tickets to recreational events, IADLs for children under 18 except for urgent health or hygiene needs, and services in a nursing facility or hospital.
Who can be a CFSS support worker
A support worker is "a qualified and trained employee" of the agency (agency model) or of the participant employer (budget model) who has direct contact with the participant. Under subd. 16, every support worker must enroll with DHS after completing a background study under chapter 245C, complete the standardized CFSS training and pass the certification test, be able to communicate with the participant, complete employer-directed orientation on the participant's needs, keep the participant's information confidential, and never independently decide medication doses or times.
Family members can be paid. Parents, stepparents, and legal guardians of a participant under 18, and a participant's spouse, may be support workers within the hour limits in subd. 7b. A participant's representative or a paid legal guardian may not be paid to provide CFSS. The full list, including the 310-hour monthly cap and the competency schedule, is in the CFSS support worker requirements guide.
How the CFSS budget or unit amount is set
The lead agency assessor determines the authorization under subd. 8. The amount is based on the participant's home care rating, which is derived from the assessed dependencies in ADLs, complex health-related needs, and behavior, plus any additional units the assessment supports. In the agency model that becomes a number of 15-minute units for a service agreement of up to 12 months. In the budget model the same assessment produces a dollar budget that the participant spends on wages, employer costs, and approved goods.
The authorization must be completed as soon as possible after the assessment and no later than 40 calendar days. A lead agency may also issue a temporary authorization under the agency model for up to 45 days without a full assessment (subd. 5a). Rates come from the DHS rate tables under § 256B.851; this guide does not state dollar amounts.
CFSS timeline
| Date | What happens |
|---|---|
| October 1, 2024 | CFSS launches; PCA service codes move to CFSS codes for transitioned participants |
| January 1, 2026 | Every EVV provider must be enrolled with HHAeXchange; 50 percent of billed visits must be EVV compliant |
| January 27, 2026 | DHS freezes new enrollment for 13 services, including CFSS agency providers (extended in July 2026 through January 27, 2027) |
| July 1, 2026 | EVV compliance threshold rises to 80 percent |
| September 30, 2027 | Every PCA and CSG participant must be on CFSS |
How agencies fit into CFSS
In the agency model, the CFSS provider agency recruits, hires, trains, supervises, and pays support workers, monitors the service delivery plan, evaluates the service within 90 days and at least quarterly (subd. 11a), and bills Minnesota Health Care Programs (MHCP) for the authorized units. Under subd. 11 the agency must spend at least 72.5 percent of its CFSS Medical Assistance revenue on support worker wages and benefits, and may not require workers to sign noncompete agreements.
Agencies also carry the electronic visit verification (EVV) obligation. Every CFSS personal care visit must be captured electronically and sent to HHAeXchange, the state aggregator, and as of July 1, 2026 at least 80 percent of billed visits must be EVV compliant. The Minnesota EVV requirements guide explains the thresholds and what happens when an agency falls short. For an agency, CFSS is therefore three linked records: the participant's authorization and plan, the worker's qualifications and competency visits, and the verified visit behind every claim.
How Trustora helps
Trustora runs PCA and CFSS agencies on one platform, so a participant record holds the MnCHOICES assessment copy, the service delivery plan and lead agency addendum, the service authorization with its unit total, and the signed participant agreement. Scheduling is bounded by the authorization period and remaining units, and the pre-claim gate checks eligibility, authorization, worker enrollment, and agency credentials before a T1019 line is released.
Worker files track the CFSS training certificate, the chapter 245C background study, MHCP enrollment and affiliation dates, and the 30-day and 90-day competency visits with alerts before a visit is due. The caregiver app on iOS and Android captures GPS clock-in and clock-out and the participant's signature and sends every visit to the HHAeXchange aggregator. See the features page for the full CFSS workflow.