Money Follows the Person: A 2013 State Survey of Transitions, Services, and Costs

Executive Summary

1. For more information see Molly O’Malley Watts et al., “Maryland’s Money Follows the Person Demonstration: Support Transitions Through Enhanced Services and Technology,” available at: https://www.kff.org/medicaid/issue-brief/marylands-money-follows-the-person-demonstration-support-transitions-through-enhanced-services-and-technology/; “Tennessee’s Money Follows the Person Demonstration: Supporting Rebalancing in a Managed Long-Term Services and Supports Model,” available at: https://www.kff.org/medicaid/issue-brief/tennessees-money-follows-the-person-demonstration-supporting-rebalancing-in-a-managed-long-term-services-and-supports-model/ and “Money Follows the Person Demonstration Program: Helping Medicaid Beneficiaries Move Back Home,” April 2014, available at: https://www.kff.org/medicaid/issue-brief/money-follows-the-person-demonstration-program-helping-medicaid-beneficiaries-move-back-home/.

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2. Only six states reported per capita costs for the population with mental illness and therefore, the per capita cost listed might not be reflective of the overall target population group.

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3. Carol V. Irvin et al., “Money Follows the Person 2012 Annual Evaluation Report,” Mathematica Policy Research, October 15, 2013, available at: http://www.mathematica-mpr.com/publications/pdfs/health/MFP_2012_Annual.pdf.

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Introduction

1. Additionally, in the summer of 2013, CMS announced a time-limited, competitive funding opportunity for existing MFP grantees called the MFP Tribal Initiative.  States can use the Tribal Initiative funds to develop state-administered community transition programs for institutionalized American Indians and Alaska Natives or to delegate program administration to a Tribe and also for program planning and implementation costs.  For more information, see http://www.medicaid.gov/State-Resource-Center/Downloads/MFP-FOA.pdf.

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2. Days that an individual resides in an institution for the sole purpose of receiving short-term rehabilitation under Medicare cannot count toward the 90-day residency period required for MFP eligibility.

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3. Molly O’Malley Watts, “Money Follows the Person: A 2012 Survey of Transitions, Services and Costs,” Kaiser Commission on Medicaid and the Uninsured, February 2013, available at: http://www.kff.org/medicaid/issue-brief/money-follows-the-person-a-2012-survey-of-transitions-services-and-costs/.

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4. Susan Reinhard, “Money Follows the Person: Un-burning Bridges and Facilitating a Return to the Community,” 36 J. of the Am. Soc’y on Aging 52, 54 (2012), available at: http://www.asaging.org/blog/money-follows-person-un-burning-bridges-and-facilitating-return-community.

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Methodology

1. At the time of the survey, Montana and South Dakota reported plans to be operational by January 2014.  As of March 2014, Montana and South Dakota are not yet fully operational.

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Key Findings

1. BIP is a new ACA LTSS option that provides financial incentives to states that implement certain structural reforms to increase access to community-based LTSS as an alternative to institutional care.

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2. Section 1915(i) provides a new Medicaid eligibility pathway due to the ACA amendment of the Deficit Reduction Act of 2005 (DRA); for more information, see http://www.hhs.gov/od/topics/community/iathcbssmd8-6-102.pdf.

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3. This enrollment projection was based on the original 30 states that received an MFP demonstration grant in 2007.

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4. Starting in 2011, CMS revised its policy to begin holding states accountable for meeting their transition goals. CMS can withhold the disbursement of MFP grant funds for those states falling far short of their transition goals. As a result, many states reduced their annual transition goals for 2010 and subsequent years. “Money Follows the Person Demonstration: Overview of State Grantee Progress,” July-December 2010,” Mathematica Policy Research, Inc., January 2011, available at: http://www.mathematica-mpr.com/publications/PDFs/health/MFP_jan-july2010_progress.pdf.

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5. The revised federal MDS assessment tool for NF residents, MDS 3.0, went into effect on October 1, 2010. Section Q of MDS 3.0 focuses on resident participation in assessment and goal setting, and is designed to identify the resident’s goals and expectations relating to where the individual lives and receives services. If a resident indicates that he or she desires to transition out of the NF to a community-based setting, the NF must initiate care planning and may make a referral to a local contact agency, which will respond by providing information to the resident about community–based services and supports.

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6. Carol V. Irvin et al., “Money Follows the Person 2012 Annual Evaluation Report,” Mathematica Policy Research, October 15, 2013, available at: http://www.mathematica-mpr.com/publications/pdfs/health/MFP_2012_Annual.pdf.

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7. Terence Ng et al., “Medicaid Home and Community-Based Service Programs: 2010 Data Update,” Kaiser Commission on Medicaid and the Uninsured, March 2014, available at: https://www.kff.org/medicaid/report/medicaid-home-and-community-based-service-programs/.

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8. Only six of 26 states serving persons with mental illness reported per capita costs for this population and therefore, the per capita cost reported might not be reflective of costs a for this target population group across the MFP demonstration programs.

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9. Carol Irvin et al., “Money Follows the Person 2012 Annual Evaluation Report,” Mathematica Policy Research, October 15, 2013, available at: http://www.mathematica-mpr.com/publications/pdfs/health/MFP_2012_Annual.pdf%20. The report calculated per person HCBS expenditures based on MFP services files and program participation data files submitted by 25 grantee states through December 2012. Costs for MFP participants were approximately $3,625 per person per month ($2,298 per elderly; $3,060 per person with a physical disability; $7,797 per person with an I/DD, and $4,158 per person with a mental illness).

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10. Carol Irvin et al., “Money Follows the Person 2012 Annual Evaluation Report,” Mathematica Policy Research, October 15, 2013, available at: http://www.mathematica-mpr.com/publications/pdfs/health/MFP_2012_Annual.pdf%20.

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11. Molly O’Malley Watts, MaryBeth Musumeci, and Erica L. Reaves, “How is the Affordable Care Act Leading to Changes in Medicaid Long-Term Services and Supports (LTSS) Today? State Adoption of Six LTSS Options,” Kaiser Commission on Medicaid and the Uninsured, April 2013, available at:http://www.kff.org/medicaid/issue-brief/how-is-the-affordable-care-act-leading-to-changes-in-medicaid-long-term-services-and-supports-ltss-today-state-adoption-of-six-ltss-options/; updates available at: https://www.kff.org/state-category/health-reform/.

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12. Ohio is one of nine states (CA, IL, MA, MI, NY, OH, SC, VA, and WA) testing a capitated model in which managed care plans will provide and coordinate Medicare and Medicaid acute, physical health, behavioral health, pharmacy, and long-term services and supports (LTSS). For many dual eligible beneficiaries, the financial alignment demonstrations will be the first time that LTSS will be coordinated with other health care services. For more information, see MaryBeth Musumeci, “Long-Term Services and Supports in the FinancialAlignment Demonstrations for Dual Eligible Beneficiaries,” Kaiser Commission on Medicaid and the Uninsured, November 2013, available at: http://www.kff.org/medicaid/issue-brief/long-term-services-and-supports-in-the-financial-alignment-demonstrations-for-dual-eligible-beneficiaries/.

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