The concept of “Follow The Money” is crucial in understanding government programs and their impact. In healthcare, this principle illuminates how funding streams shape the landscape of services, particularly for vulnerable populations. The Money Follows the Person (MFP) demonstration, a key initiative within Medicaid, perfectly exemplifies this concept. It’s designed to rebalance state long-term services and supports (LTSS) systems, moving away from institutional care towards community-based alternatives. This strategic shift not only improves the lives of countless individuals but also reflects a more person-centered and cost-effective approach to care. Through flexible funding, the MFP program empowers states to innovate, test new models, and build the necessary infrastructure to support individuals eligible for Medicaid LTSS in transitioning successfully from institutions to the familiarity and comfort of their own communities.
Since its inception, the MFP demonstration has garnered widespread participation. An impressive forty-five states, along with the District of Columbia, and territories including American Samoa and the Commonwealth of Puerto Rico, have received grant funding to plan and implement MFP demonstrations. This broad adoption underscores the recognized need and value of the program across diverse regions. Furthermore, in 2013, recognizing the unique needs of tribal communities, five MFP states were specifically awarded funding for an MFP Tribal Initiative (TI). This initiative facilitates collaboration with qualified Tribes and Tribal Organizations to develop culturally sensitive home and community-based services (HCBS) and implement strategies to reduce reliance on institutional care for Tribal members, ensuring equitable access to community-based care for all populations.
Core Goals of the “Follow the Money” Approach in MFP
The MFP program operates on a clear set of objectives, all centered around redirecting resources to enhance community-based care. These goals are designed to systemically change how long-term care is delivered and funded:
- Increase HCBS Utilization: The primary goal is to significantly increase the use of Home and Community-Based Services (HCBS) within the Medicaid program, directly reducing dependence on institutional Long-Term Services and Supports (LTSS). This “follow the money” approach ensures that funding prioritizes community-based options.
- Eliminate Systemic Barriers: The program actively works to identify and dismantle barriers within state laws, Medicaid plans, state budgets, and other areas that hinder the flexible allocation of Medicaid funds. This ensures that financial resources can effectively “follow the person” to the care setting of their choice.
- Ensure HCBS Continuity: MFP aims to strengthen the capacity of state Medicaid programs to guarantee the ongoing provision of HCBS for eligible individuals who choose to transition from institutional settings to community living. This focus on sustainability is critical for long-term success.
- Maintain and Improve Quality of Care: The program mandates the establishment of robust quality assurance procedures for individuals receiving Medicaid HCBS, at least comparable to those in qualified HCBS programs. Furthermore, it emphasizes continuous quality improvement in these services, ensuring that as money flows to community care, the quality of that care remains paramount.
Cooperative Agreements: A Collaborative Approach to “Following the Money”
The MFP demonstration utilizes a cooperative agreement model, which is distinct from a standard grant. This structure signifies a deeper level of engagement between the federal awarding agency, CMS, and the states receiving funds. This collaborative nature is essential to effectively “follow the money” and ensure program success. Unlike a typical grant, a cooperative agreement involves “substantial involvement” from CMS, fostering a partnership where CMS actively participates in and works jointly with the award recipient. This partnership includes several key components:
- Technical Assistance: CMS provides ongoing technical assistance to states, guiding them in the design, implementation, and refinement of their MFP programs.
- Federal Collaboration: CMS coordinates relevant federal collaborations to support MFP demonstrations, leveraging resources and expertise across different agencies.
- Program Evaluation: Rigorous program evaluation is built into the cooperative agreement, allowing for continuous assessment of program effectiveness and identification of best practices.
- Oversight and Monitoring: CMS provides oversight and monitoring activities to ensure program integrity and compliance, safeguarding the appropriate use of funds as they “follow the person.”
Implementing “Follow the Money” for Real-World Impact
The Money Follows the Person (MFP) demonstration has achieved tangible success in transitioning individuals from institutional facilities to community living. Thousands of people with disabilities and older adults, eligible for Medicaid long-term services and supports (LTSS), have benefited from this program. MFP success stories vividly illustrate the challenges overcome, the innovative solutions developed, and the positive outcomes realized through effective MFP demonstration programs. These stories underscore how strategically “following the money” can lead to significant improvements in people’s lives. Under the MFP demonstration, states develop and implement innovative approaches to enhance transition coordination and advance LTSS system reform. These approaches include:
- Inpatient Facility Staffing: Hiring and embedding local staff within inpatient facilities to offer options counseling to residents has proven effective in increasing transitions to community settings. By placing resources directly where individuals are, the program ensures information and support “follow the person.”
- High-Quality HCBS Standards: Reinforcing high-quality standards for home and community-based services during both transition coordination and post-transition phases is a priority. This ensures that as individuals “follow the money” to community care, they receive quality services.
- Investment in Transition Costs: MFP supports investments in critical one-time transition costs, such as home accessibility modifications and essential medical equipment. These investments directly facilitate the physical move and ensure the money enables a successful transition.
- Information Sharing: Enhancing information sharing empowers transition specialists to better understand participants’ goals and preferences, leading to an improved experience of care. This focus on personalized care ensures services truly “follow the person’s” needs.
- Strategic Partnerships: Forming strong partnerships with public housing authorities, state housing and health agencies, aging and disability networks, landlords, and developers expands housing options for individuals transitioning to the community. These partnerships are crucial to ensuring the “money follows the person” to a stable and supportive living environment.
- Tribal Initiative Engagement: Building upon existing relationships and trusted networks to engage with Tribal Nations advances the MFP Tribal Initiative, ensuring culturally appropriate services are developed and implemented. This targeted approach acknowledges that “following the money” effectively requires cultural sensitivity and tailored strategies.
Quality Improvement: Ensuring Value When You “Follow the Money”
MFP grantees have considerable flexibility in designing their programs to incorporate key HCBS system elements, including quality enhancement measures. To guide quality improvement efforts, CMS issued a State Medicaid Director Letter releasing the HCBS Quality Measure Set. This nationally standardized set of measures allows states to assess the quality and outcomes of their HCBS programs, including MFP. CMS encourages states to utilize this measure set to ensure that as funding “follows the person” and shifts towards community-based care, the quality of that care is continuously monitored and improved. CMS also plans to integrate the use of this measure set into the reporting requirements for MFP and other related programs, further emphasizing the commitment to quality and accountability.
Expanding Access: “Follow the Money” into the Future
The MFP program continues to evolve and expand its reach. Several initiatives and funding opportunities demonstrate the ongoing commitment to this approach:
Money Follows the Person Demonstration Expansion
In 2022, CMS allocated approximately $25 million in planning grants to five new states and territories through a Notice of Funding Opportunity (NOFO). These funds are specifically designed to support states in the initial planning and implementation phases of their programs, enabling them to further expand access to home and community-based services (HBCS) through Medicaid’s Money Follows the Person (MFP) program. This expansion demonstrates the continued dedication to “following the money” to broaden the program’s impact.
Changes to MFP Supplemental Services
CMS has enhanced MFP supplemental services by increasing the federal reimbursement rate to 100% and expanding the definition of these services. Supplemental services now encompass additional supports that facilitate an individual’s transition from an institution to the community, including short-term housing and food assistance. These changes directly address common barriers to community transition and aim to increase transition rates and program effectiveness. By enhancing supplemental services, CMS is ensuring that the “money follows the person” with greater impact and addresses practical needs during the transition process.
MFP HCBS Capacity Building Initiative
Recognizing the ongoing need to strengthen LTSS systems, CMS announced a supplemental funding opportunity in 2020. Up to $5 million in MFP grant funds was made available to each eligible state for planning and capacity building activities. This funding supports states in accelerating LTSS system transformation and expanding HCBS capacity. This initiative reinforces the commitment to long-term system change and ensures states have the resources to build sustainable community-based care infrastructure as they “follow the money.”
The CMS Money Follows the Person Tribal Initiative
The MFP Tribal Initiative (TI), launched in 2013, exemplifies a targeted approach to “following the money” to address specific community needs. Funding was awarded to five states to work with Tribal partners in building sustainable home and community-based services specifically for Indian Country. This initiative recognizes the unique challenges and cultural considerations in providing HCBS to American Indian and Alaska Native (AI/AN) communities and ensures that funding is directed to culturally responsive solutions. The MFP TI supports the development of in-state Medicaid HCBS programs tailored for AI/ANs and service delivery structures that empower tribes to design and manage effective LTSS programs.
Conclusion: The Impact of “Following the Money” in Healthcare
The Money Follows the Person program provides a compelling example of how strategic allocation of resources can drive significant positive change in healthcare. By intentionally “following the money” away from institutional settings and towards community-based care, the MFP program is not only transforming the lives of individuals needing long-term services and supports but also fostering a more efficient and person-centered healthcare system. The program’s ongoing expansion and refinement demonstrate a continued commitment to this vital principle, ensuring that Medicaid funding effectively supports individuals in living fulfilling lives in their communities.
