Money Follows the Person:Money Follows the Person:A Strong Foundation for Community Living A Strong Foundation for Community Living

Ron Hendler, M.P.A. MFP Technical Director

Division of Community Systems TransformationDisabled & Elderly Health Programs Group

Center for Medicaid, CHIP and Survey & Certification

MFP: Program Overview MFP: Program Overview

Significant investment in Medicaid LTC

Section 6071 of the Deficit Reduction Act of 2005 provided $1.75 billion over 5 years through awards in 2011.

The ACA amends the DRA and provides an additional $2.25 billion through Federal Fiscal years (FFY) 2016. Any unused portion of a State grant award made in 2016 would be available to the State until 2020.

Part of a comprehensive, coordinated strategy to assist States, in collaboration with stakeholders, to make widespread changes to their long-term care services and support systems.

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Principal AimsPrincipal Aims

Reduce reliance on institutional care

Develop opportunities for community-based long-term care

Enable people with disabilities to participate fully in their communities

Create a more balanced long-term care system

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Goals of MFPGoals of MFP

Transition qualified individuals from qualified institutions to qualified community-based residences.

Rebalance the long-term care system from being institutionally-based and provider-driven to “person-centered” and consumer-controlled. Eliminate barriers or mechanisms that restrict the use of

Medicaid funds so that individuals receive support for LTC services in settings of their choice

Goal of increasing HCBS rather than institutional, long-term care services

Assure HCBS quality procedures are in place and provide for continuous quality improvement.

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Home- and Community-Based Services (HCBSHome- and Community-Based Services (HCBS))

Qualified HCBS: HCBS state plan and waiver services that beneficiaries would have received regardless of his or her status as an MFP participant.

Demonstration Services: Optional services that States may opt to cover under existing Medicaid authorities but have not done so yet under their HCBS waivers or state Medicaid plan.

Supplemental Services: One-time or limited-duration services associated with transitioning to the community and would normally not be covered by Medicaid.

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Demonstration Services Demonstration Services

24-Hour Nurse Helpline

24 Hour In-home Monitoring

Telemedicine

Intense Transitional Management

Social habilitation / community integration counseling

Consumer / family / caregiver education on HCBS

Intensive home modification & assistive technology

Transition Service (start up costs)

Behavioral Crisis Management Services

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Supporting Community Living Supporting Community Living

To date, more than 12,000 transitioned from institutional settings to home and community-based settings:

Former nursing home residents < 65 are largest group of MFP participants.

Sixty-four percent of MFP participants are working age adults (21-64).

Men and women are equally represented in the program.

By CY2016, close to 67,000 individuals will transition to home and community based settings. 8

Type of Qualified Housing Total Elderly PD ID Other Unknown

Home 26.5 47.7 32.4 3.0 7.3 12.9

Apartment 24.2 18.9 34.0 10.6 6.8 29.7

Assisted living 8.8 14.1 10.4 5.0 4.2 3.1

Group home 26.0 8.4 8.9 75.0 7.8 16.7

Unknown 14.5 11.0 14.2 6.4 74.0 37.6

Community Living ArrangementsCommunity Living Arrangements

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MFP participants are relatively evenly distributed across homes, apartments, and group homes

Source: Lipson and Williams, January 2011

Housing, Housing, HousingHousing, Housing, Housing

Shortage of affordable and accessible housing and an insufficient supply of rental vouchers are the two most prevalent housing related barriers for MFP transitions.

Nearly all MFP States citing shortages in affordable, accessible housing mentioned closed or long waiting lists for public housing, limited numbers of vouchers, and difficulty placing certain types of MFP participants.

Some States report using their rebalancing fund to Promote affordable, accessible, integrated housing.

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Housing, Housing, HousingHousing, Housing, Housing

As part of the Housing Capacity Building Initiative for Community Living, the New Editions team conducted interviews with key stakeholders, including leaders from CMS, other HHS agencies, and HUD.

A key lesson from those interviews is the clear understanding that access to affordable, accessible housing is essential to the success of the MFP initiative. Part of the implication is the necessity for Federal, state and local agencies to work together, creating new relationships to foster the allocation of housing resources for people with disabilities.

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Housing, Housing, HousingHousing, Housing, Housing

Myths and Misconceptions:

Among others, common myths and misconceptions include:The idea that finding and obtaining housing is not an MFP state responsibility.The idea that public housing agencies are the only source of housing in communities, and if their list is closed, the conversation is over.The idea that “the other side’s” process is simpler/less complicated than our process. Related misconception – that the timing of both processes is synchronized.

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Opportunities for Community Living Opportunities for Community Living

Joint partnership between HUD and HHS to maximize coordination between State Public Housing Authorities, who compete for and manage vouchers, and State Human Service Agencies, including Medicaid, that provide community services and supports for people with disabilities.

In 2010, HUD awarded 4,300 (Category I) vouchers, totaling more than $33.5 million dollars, to 20 States and the District of Columbia to help support individuals with disabilities that are at risk of institutionalization to remain in the community.

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Opportunities for Community Living Opportunities for Community Living

Early this year, HUD and HHS awarded nearly one thousand additional (Category II) vouchers to 15 States to support individuals currently institutionalized in long term care settings, to return to the community and receive the necessary supports to live as independently as possible.

CMS anticipates that participants transitioning from institutions to the community under MFP and Medicaid recipients of HCBS already residing in the community will benefit from both categories of vouchers.

In addition to increasing housing vouchers, several MFP States have hired or expect to hire housing specialist, often paid for with federal administrative funding, to help build and/or increase housing capacity.

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Additional InformationAdditional Information

CMS MFP Websitewww.cms.gov/CommunityServices/20_MFP.asp

MFP Technical Assistance Website www.mfp-tac.com

Ron Hendler, MFP Technical DirectorRonald.Hendler@cms.hhs.gov

410-786-2267