Transcript Slide 1

Money Follows the Person:
A Strong Foundation for Community Living
Ron Hendler, M.P.A.
MFP Technical Director
Division of Community Systems Transformation
Disabled & Elderly Health Programs Group
Center for Medicaid, CHIP and Survey & Certification
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 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 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 “personcentered” 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 (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
 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
 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.
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Community Living Arrangements
MFP participants are relatively evenly distributed across homes,
apartments, and group homes
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
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
Assisted living
Source: Lipson and Williams, January 2011
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Housing, 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, 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, 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
 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
 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 Information
CMS MFP Website
www.cms.gov/CommunityServices/20_MFP.asp
MFP Technical Assistance Website www.mfp-tac.com
Ron Hendler, MFP Technical Director
[email protected]
410-786-2267