Money Follows the Person: Achieving Community Integration

Community integration for seniors and individuals with disabilities hasn’t always been the standard, but it is on the rise – thanks in part to programs like the Center for Medicare & Medicaid Services (CMS) Money Follows the Person (MFP) Demonstration Program. As a nation we are now at a tipping point with Medicaid dollars for Home and Community Based Services (HCBS) approximating the dollars being spent on institutionally based services.

This shift has been influenced by the 1999 Supreme Court Olmstead decision that requires states to provide services for people with disabilities in the most integrated setting, along with the rising consumer demand for community based solutions and aging in place options. CMS has responded to this demand through their new settings rule policy and guidance and by offering technical assistance and support to states to develop HCBS solutions. 

MFP is one example of a federal-state collaboration that results in increased community integration for seniors and individuals with disabilities. Operating through grants to 43 states and the District of Columbia, MFP provides funding to support both individual transitional services, as well as rebalancing through systemic changes that increase HCBS.  New Editions provides technical assistance for this program that is transforming individuals’ lives and leading to sweeping system change throughout the participating states.

As of mid-2015, 52,140 Medicaid beneficiaries had enrolled in MFP and another 10,265 transitions were in progress. MFP offers seniors and individuals with disabilities the opportunity to receive their long term care services and supports in the community. According to a recent Kaiser Family Foundation (KFF) report[i], the majority of MFP participants are individuals with physical disabilities (38%) and seniors (37%), while one in five MFP participants is an individual with an intellectual/developmental disability (I/DD). On average, MFP participants were 57 years old, took four months to transition, and most often moved to an apartment. 

These transitions are not without their challenges. For example, shortages in affordable and accessible housing, reliable and quality direct service workers, and accessible transportation impact the ability of all individuals to achieve their goal to live and fully participate in the community. Through the MFP program, states receive “rebalancing funds” that can be used to address these challenges. States are using these funds to expand and enhance HCBS waiver programs, promote awareness and access to transition services, promote access to affordable accessible housing, train direct service workers and medical professionals, develop or improve data and management information systems, develop tools to assess consumer needs and preference and other initiatives to improve and expand HCBS.

With projections of a continuing rising elderly population, the need for cost effective services and supports will be critical.  Home and community based services offer the ability to reduce individual costs for care. The KFF report indicated no state reported that institutional care was less expensive than HCBS for MFP participants. This projected rise in need is occurring as the funding for MFP program is coming to an end in 2020. Currently, New Editions is working with the grantees on their plans to sustain services and supports proven effective through the MFP demonstration. 

MFP and other HCBS activities are an important component for meeting the community living needs of Americans with disabilities and seniors.  New Editions is proud to be working with CMS and their grantees on this important work that aligns so well with our corporate commitment to improving the lives of people with disabilities and seniors. 

[i] Lessons Learned from Eight Years of Supporting Institutional to Community Transitions Through Medicaid’s Money Follows the Person Demonstration; Oct 16, 2015 | MaryBeth Musumeci and Molly O'Malley Watts