National Association of State Medicaid Directors Money Follows the Person MFP Where do we stand

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National Association of State Medicaid
DirectorsMoney Follows the Person (MFP)Where
do we stand?
November 13, 2008

• Carey Appold, Technical Director
• Disabled and Elderly Health Programs Group
• Center for Medicaid and State Operations, CMS

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Long-Term Care Spending Analysis(in billions of
dollars)
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The System of the Future Person-Centered
Long-Term Care
Vision
Key Pillars
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How Do We Get There?

• New Freedom Initiative
• http//www.cms.hhs.gov/NewFreedomInitiative/
• HCBS Waiver Programs
• Rebalancing Contract
• State Profiles
• Real Choice Systems Change Grants
• Deficit Reduction Act
• http//www.cms.hhs.gov/DeficitReductionAct/
• Money Follows the Person
• Community Alternatives to Psychiatric Residential
  Treatment Facilities for Children
• New State plan options (HCBS and Self Direction)

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MFPThe Details

• Our logo

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Goals of MFP

• Transition individuals from qualified
  institutions to qualified community-based
  residences
• Rebalance the long-term care system by
  right-sizing our institutional and
  community-based system
• 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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Individuals to be Transitioned

• Projected Number 35,572 Individuals
• Of these
• 17,183 are elderly
• 9,167are people with physical disabilities
• 6,842 are people with MR/DD
• 1,346 are people living with mental illness
• 1,034 have dual diagnoses

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MFP Fundamentals

• Enhanced FMAP for 12 months for home and
  community based services for each person
  transitioned from an institution to a
  community-setting
• Self-direction encouraged
• Rebalancing Benchmarks required
• States must participate in CMS national
  evaluation

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MFP Fundamentals Qualified Individuals

• Reside in an institution(s) for at least 6
  months.
• Institutions include hospital, nursing facility,
  or ICF/MR. IMDs are also included to the extent
  that medical assistance is available under the
  State plan for service in the IMD.
• Is receiving Medicaid benefits for inpatient
  services furnished by such inpatient facility.
• Would need HCBS services in order to successfully
  reside in community based settings.

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MFP Fundamentals Qualified Services

• Qualified HCB Program Services
• Enhanced FMAP
• Must be continued at the conclusion of the
  demonstration via waivers or State Plan.
• HCB Demonstration Services
• Enhanced FMAP
• No requirement to continue beyond the
  demonstration.
• Supplemental Demonstration Services
• Regular FMAP
• Cannot receive Federal reimbursement beyond the
  demonstration.

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MFP Fundamentals Qualified Residence

• Where can eligible individuals move?
• A home owned or leased by the individual or the
  individuals family member
• An apartment with an individual lease, with
  lockable access and egress, and which includes
  living, sleeping, bathing, and cooking areas over
  which the individual or the individuals family
  has domain and control and
• A residence, in a community based residential
  setting, in which no more than 4 unrelated
  individuals reside.

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Project Status

• Single largest investment in Medicaid LTC
• 31 States share in 1.75 Billion in funding
• Two-phased grant award
• Developmental Period
• Implementation Period
• 31 States have been approved for implementation

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Operational Protocols

• Completed during the developmental period and
  approved before grantees began to provide
  services at the enhanced match.
• Serve as the contract between the grantee and
  CMS.
• Anyone should be able to read a grants OP and
  see exactly how their MFP demonstration operates.
  Case studies are particularly valuable.
• Any potential revisions must be formally
  submitted and approved by CMS.

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Operational Protocols

• Must include information on
• Benchmarks
• Recruitment and Enrollment
• Benefits and Services
• Informed consent and guardianship
• Outreach, Marketing and Education
• Stakeholder Involvement
• Quality and consumer supports
• Housing
• Administration

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Quality

• MFP grantees must incorporate the same level of
  quality assurance (QA) and quality improvement
  (QI) activities found in the new 1915c HCBS
  waiver application.
• Additionally, MFP grantees must incorporate a
  risk assessment and mitigation process, an
  emergency back-up system for critical services
  and an incident reporting system.
• This requirement applies beyond waivers to all
  MFP State plan and supplemental services offered
  under the demonstration.

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Benchmarks

• Statutorily Mandated
• The projected number of eligible individuals in
  each target group of eligible individuals to be
  assisted in transitioning from an inpatient
  facility to a qualified residence during each
  fiscal year of the demonstration.
• Increase in qualified expenditures for HCBS
  during each year of the demonstration program.

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Benchmarks

• Potential Additional Benchmarks
• Utilization rates for a system for accessing
  information and services (i.e., the establishment
  or expansion of one-stop shops).
• Progress directed by the State to achieve
  flexible financing strategies, such as global or
  pooled financing that allow money to follow the
  person.
• Increases in available and accessible supportive
  services in the States HCBS menu.

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Role of Consumers

• Consumers and consumer-run organizations will
  have a role in the design, development, and
  implementation of the demonstration.
• Consumers and/or consumer-run organizations must
  participate in ways that go beyond advice giving
  (advisory committees).
• CMS will be looking for evidence of consumers
  involved in a decision making capacity.

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Housing, Housing, Housing

• Housing Requirements
• States must describe existing or planned
  inventories of accessible and affordable housing.
• Explain how housing shortages will be addressed
  for MFP participants.
• Explain how State Medicaid will work with housing
  finance agencies and PHAs.
• Document the types of qualified residences to
  which individuals transition.

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Evaluation and Data

• Intended to be a heavily researched project.
• Information will be collected on participant
  demographics, service utilization, cost, length
  of institutional stay, change in level of care
  and quality of life.
• Additionally, data will be collected on program
  features such as use of the emergency back-up
  system, types of community housing, barriers to
  participant recruitment, etc.

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Information Sources

• Series of MFP Outreach Calls with Interested
  Stakeholders
• Upcoming 2009 MFP Conference
• MFP Reference Manual
• MFP Resources Website
• CMS website http//www.cms.hhs.gov/DeficitReducti
  onAct/20_MFP.asp
• Technical Assistance website
• www.TAforMFP.com

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Status Report

• Transitions are not matching projections.
• 48.2 are folks with MR/DD
• 25.7 are people with PD
• 21.4 are elderly
• Roughly 1/3 of individuals assessed do not
  transition.
• Start up has been slow.
• Housing, housing, housing
• Economic downturn
• State contracting
• Multiple approaches to outreach are used
• Grassroots appears to be working (MO)