Aim­ing to move Med­i­caid pa­tients out of in­sti­tu­tions

Fed­eral pro­gram aims to help nurs­ing home pa­tients move out of their in­sti­tu­tional set­tings

Modern Healthcare - - Front Page -

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

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