Why Seniors are Moving from Institution Back Home
After living for three years in a nursing home following a stroke,
Gail, 78, went through his life savings paying for the nursing home and
eventually qualified for Medicaid. He had always wanted to and intended
to move back home, but his condition required that he stay in the
nursing home. His ex-wife, Sue, and a social worker at the nursing home
informed him about a program called “Money Follows the Person” (MFP),
which supports efforts to move institutionalized individuals back home.
In
2009, MFP enabled Gail to move into Sue’s house because she is his main
care provider. The program allotted $1,500 for home services,
modifications to the home in the form of ramps and a handicap
accessible bathroom, 16 hours of personal care services each month, and
attendance at adult day care each day. Gail’s health has remained
steady, he is able to enjoy more of a routine life, and he is able to
get the care he needs at home while surrounded by friends and family.
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OHIO MFP
CASE STUDY
Source: Kaiser Family
Foundation, www.kff.org
Overview: In January 2007 Ohio was one
of 17 states to receive funding
for the Money Follows the Person rebalancing demonstration. The state
was awarded up to $100 million in enhanced federal matching funds in
order to transition roughly 2,200 seniors and people with disabilities
from institutions to home- and community-based settings and to help
Ohio balance its long-term services and support system. Ohio’s MFP
demonstration known as HOME Choice and these statistics come from a
survey that was conducted in November 2010. It describes key features
of the program and highlights early program experiences.
Program
Features:
Ten people currently work for the MFP program in Ohio,
including specialists in each of the following areas: outreach,
enrollment, housing, population-specific community living administers,
data, and balancing long-term services and supports within the state.
Recognizing the importance of safe, affordable housing in a successful
transition, Ohio is one of six states that employ a housing specialist
within its Medicaid agency to help build partnerships with state public
housing officials.
Services
Provided:
Ohio provides
the following services: independent living skills training,
community support coaching, HOME Choice nursing services, social
work/counseling, nutrition consultation, community transition services,
transition coordination, communication aids, service animals, respite,
emergency rental and utility assistance, community living specialist,
and care management.
Transition
Progress:
Since Ohio began
enrolling MFP participants in October 2008, almost 900 individuals have
been transitioned back to the community and another 626 individuals are
in the process of transitioning. As of January 2011, the number of
seniors who were transitioned was 208, with another 149 in progress,
and 29 had been reinstitutionalized.
Cost: On average, the
cost of a HOME Choice transition for a senior was $2379/month, the
lowest cost of all categories, which included developmentally disabled
($8554/month) and physically disabled ($4519/month).
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The
U.S. Congress authorized the MFP as part of the Deficit Reduction Act
of 2005. MFP was designed to assist states in rebalancing their
long-term care systems and help Medicaid enrollees transition out of
institutions and back to their communities.
Since 2008 when
the first senior moved back home through the MFP program, an increasing
number of states have been making stories like Gail’s a reality for
seniors and others with disabilities. As of February 2011, 43 states
and the District of Columbia participate in the “Money
Follows the
Person Rebalancing Demonstration Program.” The significance
of
this program for seniors is found in its intention for establishing a
strong foundation of person-centered, consumer-directed, and
community-based services. Seniors are receiving the services they need
in an environment that is more comfortable for their recovery and/or
daily living. Ultimately, the service model is no longer
provider-driven and institution-based, but rather it is more conducive
to successful living because of the personalized approach. (Centers for
Medicare and Medicaid Services).
More recently, with
the passing of the Affordable Care Act in March of 2010, the MFP
received a boost in funding and a time extension through September 30,
2016. Additionally, the MFP program expanded the eligibility
requirements to include anyone who is in an institution for more than
90 consecutive days. The old restriction was anyone who had been
institutionalized for six months to two years. The longer an individual
has been institutionalized the more likely they are to have
relinquished a community residence and it is often more challenging for
them to again establish a community residence. Individuals who have
been institutionalized for a shorter period of time may still have a
home to which they still have access.
States have
their own methods for identifying appropriate candidates for the MFP
program. Once identified, the individual has access to the designated
funds for their case for a period of twelve months and receives
assistance in achieving the needed transition services.
After
the program is complete, the continuity of care in each state will
vary. Generally, MFP participants may be able to access existing
waivers. Participants will continue to be served through these waivers
as long as they continue to meet the eligibility criteria.
Therefore, there will not be a lapse in services for MFP demonstration
participants. Check with your state on the plans the Medicaid office
has in place for the post-demonstration period.
Challenges
that Affect the Program
While
each state handles their grant money from the MFP program differently,
each is working to gain foothold in providing opportunities for their
institutionalized citizens to regain status as community members.
Implementing a MFP program involves comprehensive and extensive
planning at the state level as well as collaboration with Centers for
Medicare and Medicaid Services. The two main challenges to the success
of the program continue to be available housing and accessibility of
community service providers.
Housing – The
number of
residential units available for Medicaid dependents is limited in any
case, and states recognize the squeeze that the MFP program places on
this issue. More and more states have launched a concerted effort in
conjunction with other government agencies such as the U.S. Department
of Housing and Urban Development (HUD) to increase their chances of
creating and locating safe and affordable housing arrangements.
Examples
of what states are doing specifically to address this problem include:
Ohio has a housing specialist under the MFP umbrella whose job it is to
build partnerships with housing officials. Michigan has 26 housing
coordinators throughout the state who identify housing opportunities
for MFP recipients (www.kff.org).
Community
services –
Already stretched thin, service providers who can provide Medicaid
supported home- and community-based services (HCBS) are difficult to
find. MFP aligns more individuals with service providers, but without
enough service providers, the MFP program recipients may not have
access to these services. States are working hard to develop HCBS
services using MFP dollars because community services are typically
more cost-effective compared to institutional care when measured on a
per-person basis.
Examples of the most commonly expanded
services that states are employing are: case management to coordinate
transition; help with home modifications; and one-time housing expenses
such as security deposits, use of assistive technology, and
transportation (Kaiser Family Foundation). North Dakota has developed a
24-hour back-up nursing service.
All of these efforts are
to create more opportunity for community-based service providers that
will support the long-term care of seniors and people with disabilities
in their homes by providing the care they need.
Successes for Seniors Now and
Long-Term
Each
year, the numbers of participants transitioning increases as solutions
to barriers are identified and significant technical assistance helps
states meet transition goals. As of December 2010, almost 12,000
individuals returned to the community as a result of these
demonstration programs, with a reinstitutionalization rate of only
about 3–4 percent.
The infrastructure that is creating
avenues to affordable housing and HCBS continues to be strengthened
through plans customized at the state level to provide support for
seniors even after MFP is slated to end. This infrastructure is
required if states plan to successfully extend the opportunity of
transitioning institutionalized individuals for the long-term.
According
to the Kaiser Family
Foundation, “MFP is likely to continue to help
states reorient their long-term services and support systems toward
more community-based care. This program in conjunction with other ACA
Medicaid policy options has the potential to expand Medicaid home and
community-based services for many more seniors and persons with
disabilities who desire to live in the community.” Kaiser Family
Foundation expects this trend to extend beyond the life of the MFP
program demonstration and have a positive long-term impact for seniors.
Resources:
To
find out if you are eligible and to apply for MFP, contact the
Department of Social Services or related Medicaid office in your state.
To get to your state’s official website, most states follow the website
address pattern of www.insertnameofyourstate.gov, i.e. www.colorado.gov.
Centers for Medicare and
Medicaid Services:
www.cms.gov
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