Transition/Diversion from Institutions

States have faced considerable challenges, but by the end of 2009, MFP programs had helped approximately 5,600 people transition to community living. This report describes the program’s status through December 2009, including how states are progressing toward their goals, and provides baseline information for analyses of impacts and outcomes.

Texas is using its MFP Demonstration to address some of the obstacles to relocation and successful access to community living through interagency collaboration, development of the necessary infrastructure to support relocation, and utilization of evidence-based practices. Attached find two presentations delivered at the 2010 HCBS conference, as well as links to the program’s on-line proposal and operational protocol.

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.

Several programs based on promising models for improving care for people with chronic conditions, who often experience difficult transitions across care settings that can compromise quality of care and increase costs were created by the heath care reform law. Most of these programs include some level of funding, evaluation, and discretion for the HHS Secretary to expand programs if they meet certain criteria. This fact sheet delineates these programs.

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.

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.

Are you looking for training materials for a nursing home diversion program? Arkansas created this Care Coordinator manual, Fact Sheet and Counseling Checklist for use at the beginning of their Nursing Home Diversion Program/Community Living Program. Also find consumer narratives and letters. The Arkansas Division of Aging and Adult Services was one of 12 state units on aging to be awarded a grant from the Administration on Aging for a new and innovative Nursing Home Diversion Program.

Many low-income individuals with severe mental illness leave state institutions without health insurance and therefore without financial access to the treatment they need to live successfully in their communities. Read an evaluation of Oklahoma’s efforts to develop and implement a model program to ensure that eligible individuals with mental illness were enrolled in Medicaid at discharge from state prisons and institutions for mental diseases.

Examine the Program of All-Inclusive Care for the Elderly (PACE), a model of care that enables frail elders to live independently in their communities. Designed as an alternative to nursing homes, PACE has received many accolades for meeting the complex needs of this population while reducing the need for hospitalization. Read about PACE's history in California, how other states are successfully increasing their PACE programs, and ideas for promoting expansion in California.