What is The Money Follows the Person Initiative, Anyway

1

• What is The Money Follows the Person
  Initiative, Anyway?
• Jason Rachel, Money Follows the Person Project
  Director, DMAS
• Julie Stanley, Director, Community Integration
  for People with Disabilities
• Governors Housing Conference
• November 13, 2008

2
Overview Money Follows the
Person Demonstration Project

• Four-year Medicaid Demonstration Project to
  assist seniors and people with disabilities who
  currently live in institutions to move to the
  community if they choose to
• Person-centered Over 1,000 individuals in
  Virginia to move to the community, each with an
  individual plan, supports they need, and someone
  to work with them before and after they move
• Community-based Partnerships among human
  services and housing agencies (local government
  and private) are key
• State-planned and administered Department of
  Medical Assistance Services (DMAS) (Virginias
  Medicaid agency) working with many other
  agencies, including state housing agencies
• Federally-sponsored Centers for Medicare and
  Medicaid Services (CMS) (federal Medicaid agency)
• State- and federally-funded 25 state/75
  federal for 1st year living in community 50/50
  thereafter

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Community Supports for Individuals Who
Transition

• Each individual will enroll in a Medicaid home
  and community-based waiver or a Medicaid
  program called PACE
• All Medicaid waivers and PACE pay for a variety
  of services available to people enrolled, based
  on their individual needs for each service
• Non-Medicaid services will also be available

4
Housing for IndividualsWho Transition

• Each individual must move to a qualified
  residence in the community
• Home owned or leased by the individual/family
  member
• Apartment leased by the individual/family member
• Setting in which no more than four unrelated
  individuals reside
• Group homes (4 or fewer beds)
• Sponsored residential settings
• 4-bed Assisted Living Facilities
• Adult Foster Care

5
Medicaid and Housing

• HUD-subsidized housing programs are largely
  Federally-driven by Congress and HUD. Medicaid
  is a Federal/State partnership. Some aspects are
  determined by the Federal government, others by
  the State.
• HUD Housing Choices Vouchers (Section 8), 202,
  811 and Hope VI programs are standardized
  programs that operate consistently across States.
  Medicaid programs can (and do) vary from state to
  state.
• Medicaid and HUD housing programs use very
  different methods to determine financial
  eligibility. A person can be eligible for a HUD
  housing program, but may not be eligible for the
  Medicaid program.
• Medicaid funds cannot be used to pay for room or
  board.

The information on this and several subsequent
slides is excerpted largely from A Medicaid
Primer for Housing Officials, Rutgers Center for
State Policy/National Academy for State Health
Policy, September 2007. A copy has been included
in your conference bag.
6

• To Understand How Money Follows the Person
  Relates to Housing, It Helps to Understand the
  Basics of the Medicaid Program

7
The Medicaid Basics

• Provides primary, acute, and long-term support
  services to individuals who meet income, resource
  and other categorical requirements (e.g.,
  residency, citizenship)
• States have considerable flexibility to determine
  who is eligible and what services will be covered
• Medicaid costs are shared between the Federal
  government and States
• Medicaid pays for a significant amount of the
  long-term support services provided to low-income
  individuals

8
Medicaid Eligibility

• Medicaid eligibility is very complicated
• Eligible individuals are entitled to all
  mandatory and optional services the State
  covers under the regular Medicaid program (called
  the State plan) if they meet the medical
  necessity criteria to receive the service
• Some people are dually eligible for both
  Medicaid and Medicare

9
Medicaids Institutional Bias

• Institutional placement is an entitlement.
• Home and community-based waiver services are
  not an entitlement. States may create waiting
  lists when they reach the maximum amount that has
  been approved for the waiver program.
• The Money Follows the Person Demonstration
  Project is designed to reverse the institutional
  bias.

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Who is Eligible for Medicaid?

• Primary eligibility categories
• Mandatory eligibility groups, e.g., people who
  receive benefits under the Supplemental Security
  Income (SSI) program
• Optional categorically needy group, e.g., people
  who receive payments under a State Supplement to
  SSI
• In Virginia, the state supplement is called an
  auxiliary grant. Auxiliary grants are
  available in assisted living facilities and adult
  foster care programs in Virginia.
• Medically needy group. States may extend Medicaid
  eligibility to additional qualified persons who
  may have too much income to qualify under
  mandatory or optional categorically needy groups
• Virginia has a Medically Needy program that
  covers seniors and people with disabilities.

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How Do People Get Long-Term Medicaid Services in
the Community?

• Services that support people to live
  independently in their home or apartment are
  primarily covered by States under home and
  community-based waiver service programs.
• The major exception is services for persons with
  mental illness, who rely heavily on mandatory and
  optional State Plan services.
• The Program of All-Inclusive Care for the Elderly
  (PACE) is a managed care program that features a
  comprehensive service delivery system to address
  the long-term needs of individuals who are
  eligible for nursing home care. The service
  package permits individuals over 55 to continue
  living at home while receiving services rather
  than be institutionalized.

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What is a Home and Community-Based Waiver?

• Home and community-based waiver services help
  individuals who are eligible for Medicaid, and
  who otherwise qualify for admission to an
  institution, to live independently in the
  community
• To be approved by CMS, the cost of waiver
  services cannot exceed what the State would have
  spent in the absence of the waiver
• Services can be targeted to certain groups or
  regions of the state
• Virginias waivers are targeted to certain
  groups, but all are available statewide.

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Waiver Eligibility

• Individuals must meet the States medical
  (functional level) criteria for admission to an
  institution
• Intermediate Care Facility for Persons with
  Mental Retardation (now known as Intellectual
  Disabilities)
• Nursing Home
• Hospital
• Individuals must meet the financial requirements
  for Medicaid

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Virginias Home and Community Based Waivers

• Elderly or Disabled with Consumer Direction
  (largest, with over 12,000 no waiting list)
• Mental Retardation/Intellectual Disability
  (waiting list for slots)
• Developmental Disabilities (waiting list for
  slots)
• Day Support (no waiting list)
• Alzheimers and Dementia Assisted Living (no
  waiting list)
• Technology-Assisted (no waiting list)
• HIV/AIDS (no waiting list)

15
Who Provides Waiver Services?

• Qualified public and private human services
  agencies who enter into a provider agreement
  with DMAS provide the bulk of waiver services.
  These are called agency-directed services.
• Some services can be consumer-directed, meaning
  that the individual using the waiver is the
  employer and therefore hires, supervises and
  fires his or her service provider. Depending on
  the waiver, the following services can be
  consumer-directed
• Personal Assistance
• Respite
• Companion
• Individual Supported Employment
• Individuals who consumer direct are assisted
  by Services Facilitators

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Can Waivers be Project-Based?

• No. Waiver services are available to eligible
  individuals and cannot be assigned to providers.
• Medicaid waiver services stay with the individual
  when the individual moves.
• CMS requires that people who use waiver services
  have a choice of all qualified providers of the
  services covered under a waiver.
• DMAS determines what providers are qualified.

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New Medicaid Services Under Money Follows the
Person

• Transition Services
• Up-front household expenses when setting up a
  household
• Being added to five waivers
• 5,000 lifetime maximum per person
• Transition Coordination
• 2 months before and 12 months after the
  individual moves
• Being added to Elderly or Disabled with Consumer
  Direction Waiver
• Consumer-Directed Individual Supported Employment
• Being added to three waivers
• 24-Hour Emergency Back-up Through 2-1-1 VIRGINIA
  for the first 12 months following transition to
  the community

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Existing and New Services To Be Added to
Waivers

• Elderly and Disabled with Consumer Direction
  (EDCD)
• Environmental Modifications
• Assistive Technology
• Transition Coordination
• Transition Services
• Technology Assisted (TECH)
• Personal Emergency Response System (PERS)
• Transition Services
• HIV/AIDS (AIDS)
• Environmental Modifications
• Personal Emergency Response System (PERS)
• Assistive Technology
• Transition Services

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Existing and New Services To Be Added to
Waivers, contd

• Individual and Family Developmental Disabilities
  Services (DD)
• Consumer Directed Individual Supported Employment
• Transition Services
• Mental Retardation (MR)
• Consumer Directed Individual Supported Employment
• Transition Services
• Day Support (DS)
• Consumer Directed Individual Supported Employment

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Non-Medicaid Services UnderMoney Follows the
Person

• Supplemental home modification funding if amount
  needed exceeds Medicaid 5,000 maximum
• Bridge rent for up to 90 days after signing a
  lease if needed for home modifications to be
  completed before the individual moves
• Funding for each provided by the Virginia
  Department of Housing and Community Development

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Waiver Services That Help People Find Community
Housing

• Depending on the waiver, one of the following
  providers is available to assist individuals
  moving to the community from institutions
• Case Managers (MR, DD and AIDs Waivers)
• Transition Coordinators (EDCD Waiver)
• Health Care Coordinators (TECH Waiver)
• These are the people who will be contacting
  housing agencies when rental assistance is needed

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The Housing Challenges

• Lack of accessible housing stock
• Housing and human services plan in different
  systems
• Inability to afford housing
• People living in institutions often have no, or
  extremely low, income.
• Sole income of many will be SSI, currently 638
  per month.
• Some gave up homes to receive services in
  institutions because they could not access the
  services and supports they needed to stay in the
  community.
• While some may obtain employment, they will not
  have sufficient income at the time of transition
  to afford rent.
• Medicaid program cannot pay
• No state-funded programs exist
• Federal housing rental vouchers are scarce, and
  those available are not dedicated to individuals
  transitioning

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What are We Doing to Addressthe Housing
Challenges?

• Operational Protocol (Project Manual) contains
  extensive section and Appendices on housing
• Transition services, environmental and
  supplemental home modifications, and bridge rent
• Qualified residences
• Owning your own home
• Renting a home or apartment (including HUD
  subsidies)
• Living in adult foster care, assisted living
  facilities, sponsored residential programs, and
  group homes
• Transportation information also included

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What Else Are We Doing to Address the Housing
Challenges?

• Housing Task Force created by Secretaries of
  Health and Human Resources and Commerce and Trade
• Centers for Independent Living (CILS) working in
  each locality with housing agencies
• Combined strategies comprise Annual Housing and
  Transportation Action Plan, delivered to
  Secretaries October 15.

25
Housing and Transportation Task Force

• Federal, state, local and private housing and
  human services partners
• Developed detailed recommendations designed to
• Increase affordability and availability of
  community housing
• Increase availability of accessible
  transportation
• Recognize importance of housing and
  transportation link
• Education, awareness, and partnership building
  among housing and human service agencies and the
  individuals they serve

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Increase affordability and availability of
housing

• Develop a community living supplement
• Increase availability of sponsored residential
  and adult foster care providers through marketing
  and provider fairs
• Make the auxiliary grant portable for all
  populations
• Produce new housing units through QAP LIHTC and
  non-LIHTC initiatives, and low-interest loan
  programs
• VHDA to form Housing Solutions Work Group
• Assess local housing capacity and assure that
  needs are included in local planning
• Direct federal housing trust fund monies, when
  they become available, to these populations

27
Recognize importance of housing and
transportation link

• Develop interactive housing and transportation
  website
• Use the existing Transportation and Housing
  Alliance Toolkit as a resource
• Create incentives to develop housing on public
  transportation routes

28
Educate housing community awareness,
partnership building

• Offer assistance in follow up to HUD and
  Governors letters to PHAs
• Provide technical assistance to local housing
  offices, planning authorities and HUD offices on
  understanding the needs of persons transitioning,
  on www.accessva.org, and on laws that govern
  housing services, options and choice Encourage
  use of Virginia Easy Access.
• Distribute Rutgers Medicaid Services Primer at
  Governors Housing Conference
• Encourage PHAs to list accessible housing units
  on www.accessva.org
• Through speaking engagements, e-distribution
  list, HUD Lines and tele-tutorials, educate
  housing-related groups, including
• VAHCDO, PHAS, Housing Counselors
• COSCDA
• Housing Commission
• Local planners and contract administrators

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Educate disability/aging communitiesawareness,
partnership building

• Orient individuals, advocates, local agencies to
  housing/transportation planning
• Disseminate Annual Action Plan
• Ensure input of disability/aging communities is
  considered in housing planning activities create
  a mechanism to track local changes in policy and
  relate ongoing needs/solutions to statewide and
  national housing funding agents and authorities
• Develop HOME, CDBG, and HCV contact lists
  disseminate to organizations to encourage
  participation in needs statements and priorities
  for resource allocation
• Document changes in housing policy work with the
  SILC to interface with multiple policy
  makers/funding agents to foster and sustain
  increased housing options
• Assure that service agencies and advocates have
  information about housing agencies and a
  description of the services they offer through
• Virginia Easy Access
• A housing resource bank on www.olmsteadva.com/mfp
  /
• Dissemination of information on HUD-Assisted
  Apartments
• Training of Transition Coordinators
• Developing a Housing Primer for services agencies
  and advocates

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Centers for Independent Living (CILS)

• CILS are contacting PHAs to ask them to partner
  with local agencies to support individuals
  transitioning under the Demonstration. They are
• offering assistance in understanding community
  living needs and preferences of people with
  disabilities and seniors
• assessing local housing capacity needs and
  working with PHAs to develop strategies to
  address the needs identified in future plans and
  planning processes
• documenting local changes in public housing
  policy, and work with PHAs to foster and sustain
  increased housing options
• A human services directory and the Medicaid
  primer will be available to all housing agencies

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How Will This Project Benefit the Housing
Community?

• Existing communication and policy gaps between
  some service providers and some housing agencies
  can be bridged
• Practical information on housing needs and
  preferences of seniors and people with
  disabilities will be provided
• Medicaid services will be offered not only to
  individuals in institutions, but also to
  individuals currently using Medicaid waiver
  services in the community
• Individuals currently using Medicaid Waivers and
  public housing can get more services they need

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For Further Information

• Visit the Money Follows the Person Website
  http//www.olmsteadva.com/mfp/
• E-mail MFP_at_dmas.virginia.gov