The Money Follows the Person Rebalancing Demonstration Program (MFP) is a Medicaid program that supports state efforts for rebalancing long-term services and supports systems. This means they devote more resources to home and community-based services (HCBS). Access to HCBS is essential for many individuals with intellectual or developmental disabilities, but states often have long waiting lists and limited funding. MFP gives people who need help with daily tasks more choices about where to live and receive services. In this article, we’ll discuss the history of Money Follows the Person, its purpose, MFP and the Affordable Care Act, and the future of MFP.
The History of Money Follows the Person
Here are some of the milestones in the history of Money Follows the Person:
1999: Olmstead v. L.C.
The Money Follows the Person program was created in response to a 1999 Supreme Court decision, Olmstead v. L.C. It found that segregation of people with intellectual or developmental disabilities is a form of unlawful discrimination under the Americans with Disabilities Act (ADA). Before this decision, many people with intellectual or developmental disabilities, mental health issues, or other problems primarily received services in long-term care facilities and other institutions. This forced many people to stay segregated from their communities.
2005: Deficit Reduction Act
Since the MFP program started in 2005 as part of the Deficit Reduction Act until the end of 2020, states have used MFP to transition more than 107,000 people to community living. The first transitions from institutions to community living facilitated by the program happened in October 2007. The ACA extended funding for MFP in 2010, and funding expired again in 2016. Congress has passed five short-term extensions since then.
2021: Consolidated Appropriations Act
The MFP program was last extended for three years as part of the Consolidated Appropriations Act of 2021 (CAA). The CAA also expanded eligibility for the program. It reduced the minimum amount of time people need to spend in an inpatient facility for MFP from 90 to 60 days. It also let individuals count the days they received skilled nursing or rehabilitation services in a certified skilled nursing facility as part of this time.
According to United Cerebral Palsy and the American Network of Community Options and Resources (ANCOR), 36 states and Washington, D.C. currently participate in Money Follows the Person. In 2016, the program included 44 states and the District of Columbia. During the first eight years of MFP, these programs transitioned more than 63,000 people from institutional settings to their communities.
A lack of reliable funding has decreased the rate of participation in the program and the number of transitions away from institutions over time. Community engagement among people with intellectual or developmental disabilities declined from 2020 to 2021, and fewer people reported going out for entertainment, errands, or meals. More funding for MFP can reverse this trend and help people live full, happy lives, and many advocates want to make Money Follows the Person a permanent program.
The Purpose of Money Follows the Person
Money Follows the Person is a federal Medicaid program that helps people move out of institutions and into their own residences, giving them more satisfaction and control over their lives and reducing health care costs. Some people who benefit from MFP move in with family members instead. MFP can also help people move into group homes with four or fewer unrelated residents. In some states, the program helps people avoid moving into institutions as well.
State Medicaid programs are required to pay for services in nursing homes and other institutions, but they don’t have to pay for home and community-based services. This can lead to a strong bias towards institutional care, and individuals often don’t have much control over how and where they receive services.
After the MFP program was introduced, the Centers for Medicare and Medicaid Services (CMS) worked with many communities to document the history of institutional care and the experiences of people entering the MFP program. Many individuals said that they hoped that the program would help them find a more affordable and dignified place to live. After participating in the program, many people experienced more satisfaction with their lives, more independence, and better sleep quality.
MFP provides grants and enhanced federal matching funds to participating states, and it uses Medicaid resources like HCBS waivers to help people manage their own care. The CMS of the U.S. Department of Health and Human Services (HHS) provides these funds, encouraging states to spend money on home and community-based services instead of long-term institutional care. It lets the CMS remove many restrictions on how funds are allocated for long-term services. MFP can help people pay for many items, including:
- Short-term or transitional housing.
- Security deposits for apartments or rental homes.
- Accommodations such as stair lifts or wheelchair ramps.
- Telehealth services.
- Service animals.
- Moving assistance.
- Adult day care.
- Home health care.
- Personal emergency response systems that let people call for help by pressing a button.
- Home visits from doctors or nurses.
However, MFP won’t help with rent or mortgage payments. Money Follows the Person programs sometimes have different names in different states. Here are some examples:
- California Community Transitions.
- I Choose Home New Jersey.
- Open Doors New York.
- Maine Homeward Bound.
- Washington Roads to Community Living.
- Hawaii Going Home Plus.
- Colorado Access to Community-Based Transitions & Services (CO-ACTS).
- My Place Louisiana.
- Kentucky Transitions.
- Ohio Home Choice.
- Oklahoma Living Choice Project.
- Take Me Home, West Virginia.
- Alabama Gateway to Community Living.
- Delaware Finding a Way Home.
- Idaho Home Choice.
- Moving Home Minnesota.
- Home Again South Carolina.
- Pathways to Community Living Illinois.
How the Money Follows the Person Program Works
The eligibility requirements for MFP vary according to the state. All over the U.S., people must live in an inpatient facility for at least 60 days and be enrolled in a state Medicaid program to qualify. People who have a Medicaid application pending can often qualify as well. This usually means that an individual can’t get MFP unless they have a monthly income lower than $2,523 and less than $2,000 in countable assets. There are only a limited number of slots for Money Follows the Person participants in each state, and people may need to spend some time on a waiting list before receiving funds.
MFP provides benefits that Medicaid recipients could potentially receive via Medicaid, even if they don’t participate in Money Follows the Person. However, not all states offer the same HCBS services through their Medicaid programs. This is why benefits can vary based on the state.
Money Follows the Person Often Gives More Than Medicaid
MFP often gives more than a state Medicaid plan or waiver program would approve. For example, someone participating in MFP could get increased behavioral health services, personal care assistance hours, or other services and supports. These benefits only last for one year from the date of a person’s transition from an institution. After that, the state’s Medicaid program will continue to provide home and community-based services for as long as an individual keeps qualifying for Medicaid.
Caregivers Create a Care Plan
To determine what type of help an individual needs, the person’s doctors and other caregivers usually assess their capabilities and the home they want to move to. Then, the caregivers collaborate with the state Medicaid office to create a care plan that suits the person’s needs. This can include selecting medical providers, medical supplies, medications, and non-medical personal care aids. Software for coordinating care can help you communicate with others and help individuals.
People Can Hire the Providers They Want
In many states, people can choose the services and supports they think will help them most. This is called Consumer Directed Care or Person Centered Planning, and it can range from being able to choose from a list of prescription medication options to having full control of a predetermined budget.
This lets individuals hire the person they want to provide care. Many people hire a relative who’s already helping them with routine tasks. These caregivers don’t need to be medical professionals, but they may need to pass some training courses, such as first aid and CPR certification. Depending on the state, they may also need a high school diploma, a background check, or training courses to become a state-certified caregiver.
A Proxy Can Make Decisions
If a person has trouble making decisions by themselves because of an intellectual or developmental disability, a proxy can make Consumer Directed Care decisions for them. However, the proxy can’t be the same person who receives money to care for the Medicaid recipient.
Financial Management Services Are Available
When a Consumer Directed Care plan gives someone a budget to completely control their care, the state Medicaid office can also provide Financial Management Services (FMS). Individuals can take care of as many financial responsibilities as they want, but they can ask the FMS representative to take care of billing and documentation, buying approved goods and services, and monitoring the budget. They can also track employee hours, issue checks, and pay tax withholding.
MFP and the Affordable Care Act
In 2010, the Patient Protection and Affordable Care Act (ACA) reduced the time frame for institutional stays needed to qualify for Money Follows the Person. It was originally six months, and the ACA reduced it to 90 days. The time required is currently 60 days. The ACA also extended MFP until September 30, 2016, and appropriated $450 million per year from 2012 to 2016. This was a total of $2.25 billion. The extension of MFP in the ACA provided opportunities for more states to participate. It also allowed current grantees to continue strengthening their existing initiatives.
The ACA’s provisions improved access to community-based care for individuals with intellectual or developmental disabilities and helped the U.S. government and states reduce health care costs for people on Medicaid and other programs. According to independent evaluations, Medicare and Medicaid expenditures decrease by an average of about 20% after people return to their community. States have made significant progress on balancing long-term services and support systems (LTSS) to improve access to HCBS, partly thanks to MFP. In 2005, states spent about 37% of their LTSS funds on HCBS. In 2020, spending on HCBS had risen to approximately 57%.
The Future of Money Follows the Person
The MFP program provides choice and dignity for many people with intellectual or developmental disabilities. However, not every state has a Money Follows the Person program. Without another extension or a bill to make the program permanent, state MFP programs could lose the funding they receive from the federal government. Some states could choose to shut down their programs, and waiting lists could become longer for the MFP programs that stay open.
More Services Are Needed
In some areas, affordable housing and community-based services aren’t available for the people who need them. Future goals of MFP include making HCBS more widely available and supporting the development of new services. There’s also a need for better coordination of care for individuals with complex medical needs. Continued support from policymakers and health care stakeholders is essential for the MFP program’s future.
A Bill to Make the Program Permanent Could Pass Soon
On December 6, 2019, Senators Chuck Grassley, a Republican from Iowa, and Ron Wyden, a Democrat from Oregon, announced that a permanent extension of the MFP program would be included in the updated version of bipartisan drug pricing legislation, the Prescription Drug Pricing Reduction Act (PDPRA) of 2019. This legislation also includes protections against spousal impoverishment for people receiving Medicaid home and community-based services. Because of the COVID-19 pandemic, Congress hasn’t voted on the PDPRA yet. The bill could pass in the future, and many advocates want to make MFP a permanent part of Medicaid.
States Could Pass Similar Laws
Before MFP becomes permanent, many states could pass legislation like New York State’s Senate Bill S1836. It established an office to advocate for people with intellectual or developmental disabilities. These types of offices can help make sure that programs like MFP are funded. They can also help eliminate any institutional biases in a state’s Medicaid system.
MFP has helped reduce health care costs for people with intellectual and developmental disabilities. It also helped people become more independent and make more of their own decisions. Thanks to MFP, more people can live on their own, have jobs, attend college, and participate in many other community activities. States have already made lots of progress, but more work is needed. There’s a shortage of qualified caregivers, and many people who want to leave an institution are still on a waiting list. Addressing challenges and improving support services are both important for the program’s future success.