Money Follows the Person

The MFP/Community Reintegration Program is part of a statewide, multi-department demonstration program with the goal of increasing the use of HCBS long-term care services and eliminating barriers that prevent or restrict flexible use of Medicaid funds for necessary services in settings reflecting individual choice. Their website includes outreach materials, program descriptions and qualifications, and numerous related links.

The North Carolina MFP demonstration project assists Medicaid-eligible individuals who live in inpatient facilities to move into their own homes and communities, and to help identify and address barriers to receiving quality, community-based care. Their website includes historical information, forms, contact information, presentations and outreach materials that can be used as templates for other states seeking to develop similar materials.

States are curtailing optional services, extending waiting lists, cutting provider reimbursement, and taking other measures to cope with the worst economic downturn in 70 years according to a comprehensive 50 state survey. Even as state revenues shrink, the demand for services is increasing. On a brighter note, many states may participate in expanded HCBS services through ACA opportunities. Review preliminary findings presented at the National HCBS Conference in September, 2010.

Findings in this report focus on what has been learned about the status of grant implementation and factors that facilitate progress early and throughout the implementation period, and progress on grantees’ goals and achievement of Systems Transformation (ST). It presents results for both FY05 and FY06 ST Grantees, builds on findings from the first annual report and focuses on two different stages of implementation for the FY05 grantees (Year 3) and the FY06 grantees(initial 15-months).

Statistics show a significant percentage increase in older persons able to receive LTSS outside of nursing homes, however unnecessary institutionalization is still a routine problem. This report clearly delineates the limitations on progress, including differences in Medicaid structure around nursing home vs. HCBS waiver coverage. The authors recommend specific steps that federal and state governments should take to reduce unnecessary institutionalization.

A number of health reform provisions give states additional options for financing HCBS services. This brief analyzes scenarios whereby states, which have significant roles in implementing many aspects of the ACA, might implement a combination of new Medicaid state plan options, enhanced Medicaid matching payments, and demonstration projects to expand HCBS care. In determining whether to adopt these options, states will assess whether they improve upon the current Medicaid authorities they use.

The authors of this report conclude that in the 10 years since the Olmstead decision, there has been little national (though some individual state) progress moving people with disabilities out of nursing facilities and public institutions and into communities with supports. The report includes an overview of Olmstead, institutional data, and recommendations for improvement.

The Affordable Care Act (ACA) includes the extension of the MFP Demonstration Program for an additional 5 years. This letter provides background about the MFP Demonstration Program, explains improvements made by the ACA, details how the ACA will impact current MFP grantees, and provides preliminary information for non-participating States that may be interested in pursuing new funding.

Review an early assessment of the balance of state LTC systems before the implementation of the MFP demonstration. The authors’ goal was to develop a baseline against which the impacts could be measured as the program matures and evolves. This baseline information is used to identify key differences in the makeup of states’ LTC systems, and the observations suggest that the impacts of the program are likely to differ across states.

Find an article produced for the general public discussing the progress of Money Follows the Person. The author cites study findings suggesting reasons for states’ slow movement in nursing home transition: problems finding affordable housing, resistance from nursing homes, stringent federal rules limiting eligibility and types of community settings individuals can move into. Included are links to a related video and interactive map showing each state’s goals and transitions made to date.