National Council on Medicaid Home Care Analyzes April Report on Money Follows the Person Utilization
May 16, 2014 03:30 PM
On April 25, the Henry J. Kaiser Family Foundation released a report titled Money Follows the Person: A 2013 State Survey of Transitions (the Report). The National Council on Medicaid Home Care – a NAHC affiliate - discusses the Report’s key findings, providing approximate numbers in most instances.
The exact numbers can be found in the original Report, here.
Overview of MFP
The Money Follows the Person Demonstration Grant (MFP) provides states with grant money for rebalancing Medicaid long-term services and supports (LTSS) for the chronically ill and disabled from institutional care to home and community-based care. Such grant money is provided for 12 months per each enrolled Medicaid beneficiary. States provide a flexible budget that the Medicaid beneficiary uses to purchase a variety of services and items to stay in the community.
MFP was authorized by Congress in 2005, and in 2010, expanded through 2016 under the Affordable Care Act. An analogous program, called the Money Follows The Person Tribal Initiative, exits for Native American communities. For a link to CMS’ description of MFP, click here.
According to the Report, in 2013, MFP had expanded to 40 states and 35,400 cumulative “transitions,” i.e. transitions from an institution to the home and community through the MFP program. This is up from 37 states and 25,100 cumulative transitions in 2012 and 31 states and 16,600 cumulative transitions in 2011.
For details, see Figure 3 of the Report, here.
Out of the 35,400 cumulatively transitioned in 2013, 13,500 were individuals with physical disabilities, 13,300 were seniors, 6,800 were individuals with intellectual/developmental disabilities, and 1,800 were individuals with mental illness. Ohio, Texas, and Washington State account for 40 percent of those cumulatively transitioned in 2013. Nationally, there are approximately 5,800 transitions in progress.
For details, see Figure 2 of the Report, here.
As of August 2013, 42 states, including Washington, DC, currently have MFP, while 6 states do not. The remaining three states either have an inactive demonstration (Oregon), or are either a new grantee or are not yet operational (Montana, South Dakota).
For the full map, see Figure 1 of the Report, here.
Forty-three states offered HCBS to MFP enrollees through HCBS waiver programs, while 34 states do so under their state plans. Such HCBS included: adult day health care, case management, habilitation, home health aide services, homemaker services, personal are services, and respite services. Additionally, eighteen states offered supplemental services including: assistive technology, employment training, home-delivered meals, ombudsman services, one-time housing expenses, and transition coordination.
Most states reported that their MFP programs have self-direction options, but also report low participation rates in that regard. The Report estimated that only approximately 19 percent of MFP participants chose to self-direct services in 2013. For details on self-direction, see page 11 of the Report, here.
According to the Report, the average age of all MFP enrollees was 58 years old, while MFP enrollees with an intellectual/developmental disability ( I/DD) averaging 46 years of age, those with mental illness averaging 49 years of age, and those with a physical disability averaging 51 years of age. Thirty-eight percent of MFP participants were physically disabled, while 37.5% were seniors, and 19% had an I/DD.
Rebalancing and “re-institutionalization”
It took MFP enrollees an average of 3.5 months to transition to a home or community setting. MFP participants were “reinstitutionalized,” i.e. returned to a hospital, intermediate care facility for individuals with I/DD, or a nursing facility, at a rate of 11 percent in 2013. This rate was slightly higher than the 8 percent reported in both 2011 and 2012.
Per-capita expenditures. The average per capita monthly expenditure for all MFP participants in 2013 was $3,900, a decrease from $4,400 in 2012. The average per capita monthly expenditure in 2013 was $7,500 for I/DD participants, $2,900 for the physically disabled, $2,600 for those with mental illness, and $2,200 for seniors.
Cost containment. Only five states noted that there were or will be cuts to their MFP programs due to fiscal concerns.
Other LTSS Priorities. Forty states with MFP are implementing or will implement at least one more Medicaid rebalancing program, such as a Section 1915(i) State Plan Option, a health home, the Balancing Incentive Program, and/or the Section 1915(k) Community First Choice state plan option. Twenty-four states have MFP participants in their managed LTSS programs.
Self-direction. Home care agencies should note that self-direction is not as widespread in MFP as it is in HCBS waivers. The Council supports self-directed models of care that are compliments of, and not replacements for, agency models of care. The Council also supports these self-directed models as long as beneficiaries are afforded the same level of care and protections as those in an agency-model of care.
For details, see pages 14 and 15 of our 2014 policy blueprint, here.
Cost containment. The Report noted that per-capita MFP expenditures decreased in 2013 from 2012 levels, and that only five states expressed concerns that MFP would cause significant fiscal concerns. This reaffirms the Council’s position that MFP, and rebalancing programs generally, are cost-effective.
Home care agencies are advised to continue to monitor Money Follows the Person in their states, and contact the Council with any questions or concerns.