Aiming to move Medicaid patients out of institutions
Federal program aims to help nursing home patients move out of their institutional settings
As lawmakers at federal and state levels debate policy changes to cut spending on Medicaid, the CMS is moving forward with a program that aims to reduce long-term-care spending by transitioning Medicaid beneficiaries living in nursing homes back into community settings.
The “money follows the person” demonstration projects, at various stages of operation in 43 states, redirect Medicaid spending from institutional care to community-based care. With this initiative, the CMS aims to rebalance the program’s bias toward paying for long-term care in nursing homes.
By means of a new partnership between the Housing and Urban Development Department and HHS, the CMS hopes to eliminate the biggest barrier to the program’s success— securing affordable and accessible housing for the participants.
HUD announced this year that it would award housing vouchers specifically to Medicaid beneficiaries living in institutional settings who want to return to life outside of a nursing home. As MFP programs in some states mark their third anniversary this summer, project directors are working with local public housing authorities to help individuals successfully transition back to community living.
“It was an excellent opportunity for us to work together with HUD to make sure this would happen,” says Henry Claypool, director of HHS’ Office on Disability. “We’ve formed a working group and we’ve been working at a variety of different levels of the two departments to make sure we can achieve the outcomes that the president and the (department) secretaries are looking for, which is to
Focus on community
make these transitions work.”
“This was a rare opportunity for us to reach out to the HHS folks and CMS folks and say, ‘Does this connect between how you see this world and how you see the services that need to be delivered?’” says Fred Karnas, senior adviser to HUD Secretary Shaun Donovan.
Established by the 2005 Deficit Reduction Act and extended by the 2010 Patient Protection and Affordable Care Act, MFP enables state Medicaid program officers to use funds that they would normally use to pay for institutional care to instead pay for long-term-care services in a community setting.
Elderly, physically disabled, developmentally disabled and mentally ill individuals who are eligible for Medicaid and need assistance with activities of daily living often end up in nursing homes by default.
“Once you are in a hospital, if you acquire a condition there, the easiest place to discharge you to is the nursing home,” Claypool says. “States end up with people in nursing homes that might not really need to be there and that could be served in the community.”
Starting in fall 2007, 30 states and the District of Columbia, with funding from the CMS, began developing MFP demonstration projects. In the midst of an economic downturn that has led to state budget deficits, administrators have been learning how to cultivate, coordinate and connect Medicaid beneficiaries requiring long-termcare services to care outside of an institution.
While Medicaid must pay for institutional care, long-term-care services that support community living are not entitlements. Provisions in the Deficit Reduction Act allow state Medicaid programs to reimburse for long-term care delivered by community-based providers.
“We have a variety of providers that specialize in serving different groups of people with disabilities and the guidance they receive from the CMS really is much more along the lines of using the flexibility of the Medicaid program to provide the community-based services that the individuals need so that they can have a full life in the community,” Claypool says.
The supports and services that MFP enrollees need vary by individual. A person with a physical disability may need a personal aide to perform household chores such as grocery shopping, doing the laundry or running errands. An elderly person with limited mobility may need a home health aide a few hours each day to help with activities such as eating, dressing and bathing. A person with developmental disabilities might need a live-in caregiver to successfully transition back to independent living.
“There isn’t one condition or one particular disability that would disqualify anybody from participating,” Claypool says. “We are always amazed at how people with really significant disabilities really thrive when they get into the community. Sometimes they struggle with the