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The Money Follows the Person Demonstration: Early Program Evaluation Analysis

This paper synthesizes findings from six evaluation studies focusing on the Money Follows the Person (MFP) demonstration grant program. The studies provide needs assessments of state long-term care systems and early analyses of how the MFP program has been implemented across the thirty demonstration states. The studies reveal varied levels of success and some common challenges that states have encountered in implementing their transition and rebalancing programs. Introduction The MFP demonstration grant program is the latest in a series of federal initiatives to rebalance state Medicaid long-term care systems. The MFP program was designed to help states reduce their reliance on institutional care and expand options for older people and persons with disabilities to receive care in the community. The MFP program was authorized by Congress under Sec. 6071 of the Deficit Reduction Act (DRA) of 2005 (P.L. 109-171) and is currently being administered through the Centers for Medicare and Medicaid Services (CMS). Under the MFP program, 31 state grantees were awarded a total of $1.44 billion to implement transition and rebalancing programs between 2007 and 2011. (See Appendix 1 for a table listing the state grantees, their transition goals and funding awards.) The transition programs are designed to move Medicaid eligible enrollees in institutional care back into the community. The rebalancing programs use enhanced 1 CMS, “Money Follows the Person Rebalancing Demonstration,” Funding Opportunity No. HHS-2007CMS-RCMFTP-0003, DHHS, July 26, 2006; available at: http://www.cms.hhs.gov/NewFreedomInitiative/downloads/MFP_2007_Announcement.pdf. 2 South Carolina decided not to implement a MFP demonstration program reducing the number of state grantees to thirty. 2 matching funds for home and community-based services and reinvest them in more consumer-directed models of care and overall service delivery changes. This paper synthesizes six evaluation studies focusing on long-term care systems before and during early implementation of the MFP demonstration program to better understand the need for the MFP initiatives and how states have implemented their programs so far. This review provides an assessment of some early challenges and opportunities that MFP grantees have encountered. The evaluations highlight a number of common barriers and keys to success as states have worked to implement their transition and rebalancing programs. States with more advanced Medicaid programs requiring fewer system changes and with greater experience in transitioning individuals from institutions to community settings have had more initial success in implementing their MFP programs. Some of the common barriers have been difficulty in finding appropriate housing for transition candidates, the limited definition of a qualified residence under the program, and the requirement that eligible Medicaid enrollees be institutionalized for a minimum of six months. As programs are fully implemented throughout the demonstration period additional analyses will likely uncover key factors relevant to MFP program goals. In addition, key policy changes made to the MFP program through the Patient Protection and Affordable Care Act (P.L. 111-148), should have significant bearing on the success of MFP demonstration states in the future.