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Approximately $4.3 billion in federal funds have been made available to help states establish and expand home- and community-based long-term services and supports for older adults and people with disabilities.

The new funds will support the Money Follows the Person (MFP) demonstration program, which the Affordable Care Act (ACA) extended for an additional five years through 2016, and the Community First Choice Option, which the ACA created.

U.S. Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced the availability of the funds on February 22.

Money Follows the Person

The MFP program helps individuals transition from living in a nursing home or other institution to living in the community with the services and supports they need.

The new funding will enable 13 additional states [scroll down to see chart] to help an estimated 13,000 people move into the community. Twenty-nine states and the District of Columbia already operate MFP programs. Together, these states will receive more than $45 million in the first year of the program.

Since 2008, PHI and its colleagues at the Direct Service Workforce Resource Center have provided technical assistance to states participating in MFP, supporting their efforts to ensure the workforce necessary to meet the service and support needs of the people transitioning into the community.

A recent study (pdf) by the Kaiser Commission on Medicaid and the Uninsured found that inadequate community workforce supply, along with lack of affordable housing, were the key obstacles to the success of this program.

Community First Choice Option

Sebelius also announced funding and the posting of a proposed rule (pdf) for the Community First Choice Option (CFC) program. This proposed rule describes details of CFC and solicits public comment for 60 days.

CFC, which will take effect in October 2011, gives participating states a 6 percent increase in federal Medicaid matching funds to provide community-based attendant services and supports to older adults and people with disabilities with Medicaid.

Between 2011 and 2014, the federal government is prepared to provide $3.7 billion in new funds to participating states to support the provision of these services.

Some state-level advocates for older adults and people with disabilities see CFC as crucial in providing new federal matching funds for states considering drastic cuts to home- and community-based services.

Advocates in California hope CFC funding can help offset costs to the In-Home Supportive Services (IHSS) program and avoid the need for implementing cuts to this and other Medicaid programs.

New PHI Fact Sheet

To learn more about CFC and other ACA provisions for home- and community-based services, see PHI’s new Health Care for Health Care Workers Health Reform Facts 5: Home- and Community-Based Services Expansion Offers Opportunity to Improve Direct-Care Jobs.

– by Gail MacInnes, PHI National Policy Analyst

A provision in the health reform law extends the Money Follows the Person (MFP) Rebalancing Demonstration program for another five years, until 2016.

The Centers for Medicare and Medicaid Services (CMS) sent a letter (pdf) to state Medicaid directors in an effort to get states to participate. To make it easier for the 29 states (and the District of Columbia) that took part in the original MFP demonstration to do so again, the agency has streamlined the enrollment process significantly.

States that did not participate in the initial MFP demonstration can apply for the second phase. CMS plans to post guidelines later in July on how these states can apply, and will select states on a competitive basis.

The MFP demonstration program provides funding to states to facilitate the development of community-based long-term care programs instead of institutional care to provide services and supports to elders and people with disabilities who receive Medicaid.

Benefits to States that Participate

In late June, CMS sent a letter to state Medicaid directors to highlight the advantages of participating in the extended MFP program, including:

• enhanced Federal Medical Assistance Percentage rate for qualified services;
• national technical assistance and supplemental services;
• full reimbursement for some administrative costs; and
• reimbursement of home and community-based services and demonstration services at an enhanced rate.

Congress authorized the MFP program to be extended until 2016 and provided $2.25 billion. The initial five-year MFP demonstration had a $1.75 million budget and was set to expire in 2011.

Inside Health Policy reports that the MFP program made it possible for 6,000 people to move from institutional to community-based care by 2009.

PHI Provides Technical Assistance to MFP Program

“We were very pleased that Congress decided to extend the MFP demonstration program in health reform,” said PHI National Policy Director Steve Edelstein. “MFP has been an important vehicle not only for expanding home and community-based services but also for states to pursue initiatives for support and an adequate and stable workforce to provide those services.”

For the past year, PHI has been providing technical assistance on workforce issues to a number of state MFP grantees through the Direct Service Workforce Resource Center. The PHI policy team has been helping with workforce data collection and monitoring, providing guidance on procurement and incentive payment polices, and providing support for entry training programs.

PHI National Director of Curriculum & Workforce Development Peggy Powell is working with MFP demonstration staff in the District of Columbia, by assisting in the development and implementation of a values-based pilot training program for community-based, direct-support workers and other provider agency staff.

The goal of the training is to increase the trainees’ understanding of a person-centered approach in meeting the needs and preferences of their program participants and supporting fuller community integration.
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Powell noted, “During our recent interviews with community residence and day program staff, we consistently heard them express how important it is to provide this opportunity and choice for consumers, and the need to help direct-support staff develop the knowledge and skills necessary to achieve MFP’s vision for full community integration.”

– by Deane Beebe