Money Follows the Person

This letter was issued to provide information on new tools for community integration and to remind States of existing tools that remain strong resources in their efforts to support community living. Various technical assistance resources are listed, including a new guide for enhancing the availability of HCBS within managed care delivery systems. Progress around the HUD partnership, HCBS waiver and state plan options, grant programs, ADRCs and discharge planning are discussed as well.

This bibliography summarizes current thinking about developing core competencies for all direct care workers, regardless of the setting they work in. It includes recommendations from six state-level reports, two national studies, and the federal Retooling the Health Care Workforce for an Aging America Act.

This report synthesizes information from in-person interviews with program staff, a mail survey of program counselors, and telephone interviews with consumers who had the opportunity to receive the program allowance. It also discusses the program's goals and features, how consumers managed their responsibilities under it and made use of its flexibility, and levels of consumer satisfaction with the program.

This report presents Medicaid long-term care expenditures data in Federal Fiscal Year 2008 (Oct 2007 - Sept 2008). Table 1 shows national data from 1996 - 2008. Other tables present state-by-state data for nursing homes, ICF/MR, state plan personal care, state plan home health, 1915(c) waivers, 1115 waivers that provide HCBS, and other Medicaid services.

This is the third report in a series, from Mathematica's five-year evaluation of the Money Follows Person demonstration, aimed at helping Medicaid enrollees transition, from long-term care institutions to the community. It describes states’ early implementation experiences and state transition activity as of December 2008. Also discussed, are the challenges that states have encountered in trying to launch the program, and implications for making fundamental changes in the long-term care system.

As part of Research on Program Management Techniques by States to Rebalance their Long Term Care Systems, Final Case Studies were conducted in each State for the time period ending December 2007. These Case Studies focus particularly on the reflections of State government officials on rebalancing goals, accomplishments, and next steps as they reflect on all the State’s experiences in moving towards more community-based services.

The purpose of this report is fourfold: 1) to present a brief overview of the results of the Systems Change grants awarded from FY 2001 through FY 2004, 2) to describe the remaining challenges to community living that Grantees identified, 3) to provide Grantees’ recommendations for actions needed at the state and federal level to further improve their long-term care systems, and 4) to discuss the key lessons learned regarding factors that are needed to improve states’ long-term care systems.

One goal of long-term care policy is to increase the use of HCBS and to reduce reliance on institutional care. The use of nursing homes as measured by the number of residents in facilities on a single day has declined over the past two decades. Despite the centrality of this issue for balancing efforts, there has been no systematic effort to examine the reasons. This report begins to fill the gap by conducting descriptive analyses of factors. In most cases, analyses were to extend to 2007.

How can states use debit cards in their consumer-directed purchasing programs? The Sept 2009 Community Living Partnership TA Call addressed this financial management question. States have used pre-paid plans as part of their MFP and CLP grants. Review a matrix of pre-paid card companies and their methods for spending. Also included is a Proposed Procedure for Debit Card Purchases developed for the Veterans-Directed Home and Community Based Services Programs.

This issue brief examines the early successes and challenges of MFP. A 2008 survey of 29 states receiving MFP grants turned up several key findings, including that several hundred people have moved from institutional to community settings; that states are providing a broad range of services to facilitate transition; that housing issues for MFP participants are a major challenge for states; and that the severe economic downturn had not yet prompted states to scale back their efforts.