May 3, 2010
CONNECTICUT MONEY FOLLOWS THE PERSON PROGRAM
By: Saul Spigel, Chief Analyst
You asked for a description of Connecticut's Money Follows the Person Program.
Money Follows the Person (MFP) is a federal demonstration program designed to help states rebalance their long-term care systems to better support people living in institutions who want instead to live in the community. It is intended to serve elderly people and others with mental illness and developmental disabilities. Connecticut is one of 29 states (plus the District of Columbia) participating in the demonstration.
The federal program began in October 2007. It supports states' efforts to move their long-term care systems toward a more community-based approach by offering them (1) enhanced Medicaid reimbursement for demonstration program services (in Connecticut this means approximately 80% reimbursement rather than the normal 50%) and (2) flexibility to provide supplemental services that Medicaid would not normally cover. States are expected to reinvest the savings they realize by moving people out of nursing homes in home- and community-based services.
The Department of Social Services (DSS) began implementing MFP in December 2008. To be eligible a person must (1) have been institutionalized for at least six months and (2) meet Medicaid eligibility criteria. In addition, it cannot cost more to care for the person in the community than in an institution. After someone qualifies for MFP, DSS assesses the person's service needs, develops a care plan for him or her, and helps the person find housing and services.
All participants can obtain skilled nursing; physical, occupational, and speech therapy; homemaker and home health aide services; medical social services; and durable medical equipment. A wider range of services is available for specific populations, such as a rehabilitation option for people with mental illness, assisted living and specialized medical equipment (for the elderly and people with mental retardation (MR)), case management and meal delivery (for the elderly and people with acquired brain injury (ABI)), and day habilitation and supported employment (for people with MR and ABI).
In its 14 months of operation (December 2008 through January 2010), DSS moved 176 people into the community. It estimates that the cost of serving them in the community is about one-third the cost of their nursing home care.
The legislature has also directed DSS to plan for a program to extend MFP services to adults who may not meet the MFP federally mandated six-month institutionalization requirement. But in 2009 it postponed implementation of this “MFP II” program until 2012.
CONNECTICUT MFP PROGRAM
DSS received federal approval to operate an MFP demonstration in June 2007, which it began in December 2008. DSS, in collaboration with a variety of other public and private organizations, established five goals for MFP:
1. transition at least 700 people from qualified institutions to the community (the goal has been raised to 890 people),
2. increase funding for home- and community-based services,
3. increase hospital discharges to the community rather than institutions,
4. increase the probability of a person returning to the community during the six months following nursing home admission, and
5. increase the percentage of people needing long-term care living in the community compared to an institution.
Elderly people and those with physical, mental, and intellectual disabilities can participate in MFP. In order to participate, a person must (1) have been institutionalized for at least six months and (2) meet Medicaid eligibility criteria. In addition, the cost of caring for the person in the community must be no more than the cost of institutional care.
A person applies to DSS to participate in MFP. DSS staff determines whether the person meets the eligibility criteria and, if so, assess whether the level of care he or she needs is compatible with the services MFP can provide. People with mental illness or intellectual disabilities are assessed by staff from the Mental Health and Addiction Services (DMHAS) and Developmental Disabilities (DDS) departments, respectively. After the level of care is assessed, DSS or an agency with which it contracts assesses the specific services the person needs and develops a care plan.
Field staff tries to contact the nursing home patient within three days after DSS decides a needs assessment is appropriate and first visit the patient within two weeks. The field staff develops an individual care plan for the patient, which DSS must approve before the person's transition from the nursing home can begin. (DSS refers people who are not eligible for MFP to other home- and community-based services.) Staff also obtain informed consent from the person, which is required before someone can participate in MFP.
MFP participants are reevaluated for continuing participation every 11 months. If a participant is reinstutionalized, he or she is disenrolled from MFP but can reapply if the reinstitutionalization lasts less than six months.
MFP services include the following Medicaid State Plan option benefits: skilled nursing; physical, occupational, and speech therapy; homemaker and home health aide services; medical social services; durable medical equipment; and a rehabilitation option for individuals with mental illness. MFP also provides services targeted to specific populations, such as the elderly and people with ABI and mental retardation MR, that are already available to people in such groups who participate in the state's home- and community-based services Medicaid waiver programs. These include assisted living and specialized medical equipment (for the elderly and people with MR), case management and meal delivery (for the elderly and people with ABI), and day habilitation and supported employment (for people with MR and ABI).
As of January 31, 2010, 1,140 people had applied for MFP. DSS estimated this figure represented 6% of the total eligible institutionalized population. Most of the applications were received within two months after the program began in December 2008. The demand exceeded initial estimates, which led DSS to postpone outreach activities it had planned to introduce MFP.
Nearly all of the 1,140 applicants were referred for a needs assessment. By the end of January 2010, 785 (70%) had completed the process and signed informed consent forms. Of these, 248 (32%) were targeted for elderly services, 246 (31%) for personal care assistance (PCA) services, 173 (22%) for mental health services, 90 (11%) for ABI services, and 28 (4%) for developmental disabilities (DD) services.
DSS has approved care plans for 324 (41%) of the 785 people with a completed assessment. Of this group, 80 (24%) were approved for elderly services, 19 (6%) for ABI, 107 (33%) for PCA (elderly and nonelderly with disabilities), 44 (14%) for mental health, and 4 (1%) for DD. The remaining 70 care plans (22%) were for people leaving a nursing home and receiving traditional Medicaid services, not MFP.
After their care plans are approved, MFP participants must find a place to live in the community and the services called for in their care plans. DSS transition and housing coordinators help them do this. The housing search typically takes about two months; people sometimes have trouble finding appropriate housing or time is needed to modify a dwelling to their needs. Of the 324 people with approved care plans, 176 (54%) had moved to the community by January 31, 2010, in about the same proportions as above for those with approved care plans.
People who transition to MFP must select the kind of housing in which they wish to live from a range of options: their own home or one owned by a family member, an apartment they lease, assisted living, or a group home. Through January 31, 2010, 28% of MFP participants had
moved into their own or a family member's home, 69% moved into their own apartments (37% with help from DSS rent assistance), while the remaining 3% moved into group homes or assisted living.
DSS' early data suggests that MFP is cost-effective. As table 1 shows, the net, per client cost to the state for an MFP client is $963 compared to $2,650 for a client in a skilled nursing home.
Table 1: Nursing Home-MFP Cost Comparison
Skilled Nursing Home
Net to State
Source: DSS, Money Follows the Person Rebalancing Demonstration Legislative
Status Update, 10/09
In a 2008 act, the legislature required the DSS commissioner to develop a plan to establish and administer a home- and community-based services project like MFP for adults who may not meet MFP's federally mandated six-month institutionalization requirement (PA 08-80). This project has been called MFP II. But in 2009 it (1) postponed, from January 1, 2009 to January 1, 2012, the date for DSS to submit an MFP II implementation plan for legislative review and (2) delayed implementation from July 1, 2009 to July 1, 2012 (PA 09-5, SSS).