MFP Increased HCBS and Saved Money

Members | December 05, 2017 | by Peter Notarstefano

The Centers for Medicare & Medicaid Services published the Money Follows the Person (MFP) Rebalancing Demonstration Report to the President and Congress. The national evaluation found positive signs that the demonstration was effective.

The Centers for Medicare & Medicaid Services published the Money Follows the Person (MFP) Rebalancing Demonstration Report to the President and Congress. The MFP Rebalancing Demonstration program was launched more than nine years ago. As of September 2016, the 44 grantee states were awarded nearly $3.7 billion in grant funding. As of the end of the calendar year 2015, grantee states had transitioned a total of 63,337 Medicaid beneficiaries from long-term institutional care to community residences and home and community-based LTSS.  Costs of care for MFP participants transitioned through 2013 was reduced by $978 million during the first year after the transition to home and community-based LTSS.  The national evaluation found positive signs that the demonstration was effective. Since 2012, MFP grantee states have transitioned more than 10,000 beneficiaries on an annual basis and by the end of December 2015, the grantee states transitioned a cumulative total of 63,337 Medicaid beneficiaries from long-term institutional care to community-based LTSS.

MFP participants have been younger and disproportionately minorities, men, and Medicaid-only beneficiaries (less likely to be dually eligible for Medicaid and Medicare) compared with the older adults eligible for the MFP demonstration. Older adult MFP participants have  been less functionally impaired; the functional impairment scores for MFP participants in 2008 indicate that on average they were completely dependent in 2.5 out of 7 activities of daily living and the eligible population had scores that indicated complete dependence in 4.0 out of 7 activities on average (impairment was higher in 2012, the eligible population on average was completely dependent in 4.5 activities compared to 3.0 activities among MFP participants that year). However, depending on the year, between 59 and 79 percent of older adults transitioned by MFP had moderate to high level of care needs and between 39 and 57 percent had moderate to severe cognitive impairment. Similarly, between 52 and 78 percent of younger adults with physical disabilities transitioned by MFP demonstrations had moderate to high level of care needs and between 22 and 59 percent had moderate to severe cognitive impairment depending on the year.

Reported challenges for transitioning MFP participants to the community included:

  • Insufficient supply of affordable and accessible housing, including lack of available housing choice vouchers (the most commonly reported challenge since the inception of the demonstration);
  • Reductions in the number of referrals received;
  • Staff shortages, including transition coordinators and case managers;
  • Lengthy transition periods; 
  • Difficulty coordinating with relevant state agencies.

LeadingAge is pleased that there is bipartisan support for the extension of funding and improvements for the Money Follows the Person Demonstration. We encourage Congress to address the challenges in transitioning an older adult from a nursing home back into the community, especially the insufficient supply of affordable and accessible housing. A secondary effect of the MFP Demonstration that requiring states to demonstrate a maintenance of effort to continue access to home and community based services is  the commitment by most states to continue services that facilitate access to services in the community.