Transition/Diversion from Institutions

AoA launched the CLP initiative in the fall of 2007 with a vision to help states create person-centered programs that reach people at risk of institutionalization before they enter a nursing home. Since 2007, approximately $36 million has been invested in 28 states to develop the CLP program. With the implementation of the 2009 CLP grants, there will be more than 120 CLP program sites nationally. This fact sheet includes the program’s background, AoA’s vision for CLP and a list of the grantees.

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.

This report is the result of a study exploring management techniques and programs States have put in place to rebalance their Medicaid long-term supportive services. It summarizes the methods, products and findings of this project then suggests conclusions and recommendations for State officials, legislators, advocates, and providers and CMS on ways to increase and improve LTSS systems for people with disabilities, enhance participant choice, and reduce reliance on institutions.

The California Community Choices (Choices) project is designed to increase consumer access to home and community-based long-term care services and to provide additional centralized sources of information and referral. The Choices project includes a study to improve the state’s understanding of the financial and structural barriers to increasing consumer access to these services, and to provide recommendations to the state to more effectively manage funding for long-term care.

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.

This second report in a series focuses on how state variation in level of experience and infrastructure to undertake large-scale transition programs can affect implementation. The authors describe differences in strategies to 1) expand transition coordination capacity 2) locate appropriate housing 3) enhance long-term supports & services 4) change Medicaid HCBS programs/policies to ensure that those who transition can remain in the community after the MFP eligibility period ends.

The study analyzes the long term care (LTC) system in WV and projects costs and savings associated with two models of efforts to transition people out of institutions. The system analysis looks at service delivery in both institutional and community-based settings, levels of access, financing, and quality. The appendices include examinations of care models and rebalancing efforts of other states.

Quantitative and qualitative data are pulled together for a summary of the enrollment and implementation experiences of state DMIE projects through December 2008. The Kansas, Minnesota, Texas, Hawaii and District of Columbia programs are profiled and then a national summary and implications are presented. Another report tentatively scheduled for the spring of 2010 will analyze whether the program improved outcomes for individuals and evaluate the implementation and phase-down activities.

In two short videos, Lana and Janet, participants in the Missouri MFP program, share their experiences moving out of nursing homes. They also discuss some program details and encourage others to sign up. The videos were produced by the Disability Resource Association to promote MFP.