Transition/Diversion from Institutions

Many states are undergoing long-term services & supports (LTSS) transformations. The lagging economy & increased demand for publicly funded LTSS are placing pressure on state policymakers to find solutions. As a result, many states either have or plan to implement Medicaid Managed LTSS, with 12 states having existing programs & another 11 with plans for implementation. Many states used the economic downturn as an opportunity to balance services from institutional to non-institutional settings.

Enrollment in MFP continued to grow steadily with 15,818 cumulative transitions to the community as of June 30, 2011, a 33 percent increase from the end of 2010. The states reported 3,722 new transitions during the six-month period from January to June 2011, 9 percent more than in the previous six-month period. The report provides an overview of state MFP grantee progress on key performance indicators and challenges states reported when implementing their transition programs.

State aging & disability agencies are operating in an era of state agency reorganization, re-conceptualization of state government, & restructuring of long-term services & supports delivery systems & financing. Key elements driving continued change include the economic environment, ACA implementation, uncertainty in the federal budget particularly with the failure of the Congressional Super Committee, changes in state level leadership, & the 2012 elections.

This brief describes key features of Georgia’s MFP program & highlights recent experiences. Through MFP, Georgia has achieved a 2 percent growth in annual spending on home & community-based services. With the extension of MFP under the ACA, the state plans to continue the program through 2016 with hopes to transition more than 2,000 individuals with the help of over $93 million in enhanced federal matching funds. Also, review brief profiles on several Georgia residents enrolled in the program.

This report examines state policies that are needed to help older adults age in place. These policies include integrating land use, housing and transportation; efficiently delivering services in the home; providing more transportation choices, particularly for older adults who no longer drive; and improving affordable, accessible housing to prevent social isolation.

Implementing an MFP program and looking for ideas on policy? The State of Texas was one of the originators of the "money follows the person" (MFP) concept. Review the website which offers definitions and policies.

This Primer has been updated to include all relevant statutory, regulatory and other policy changes that have occurred in the last 10 years in Medicaid home and community services. Given the significance of recent changes, this Primer will be an even more useful tool for all those working to ensure that people with disabilities can live in the most integrated settings appropriate to their needs.

Is your state looking for a nice example of how to introduce waiver programs to the community? Review this guide, which provides an overview of the various programs. The guide outlines what services are covered and how to apply for various programs.

With the growing role of home and community-based services in Medicaid long-term services & supports, an understanding of the different characteristics of the population transitioning from institutional care to HCBS, the trends occurring in LTSS & the effect of the different programs is needed. Hilltop developed a series of metrics to present to the Maryland Money Follows the Person Stakeholder Advisory Group now in the form of chart books. These metrics can be tailored for any state.

A review of 36 studies of outcomes for nearly 5,000 people with intellectual & developmental disabilities moving from large institutions to community living arrangements found high consistency in positive change in daily living skills. Studies specifically addressing social skill development, language & communication skills development, self-care & domestic skill development & community living skill development also showed positive outcomes associated with leaving large institutions.