The landscape of long-term care in the United States is undergoing a significant shift, moving away from traditional institutional settings towards community-based care. At the heart of this transformation is the Money Follows the Person (MFP) demonstration, a program funded through Medicaid, designed to rebalance state long-term services and supports systems (LTSS). For individuals eligible for Medicaid LTSS, MFP opens doors to receiving necessary support within their communities rather than being confined to institutions. Understanding the Terms For Money within this initiative is crucial to grasping its impact and mechanisms.
Since its inception, the MFP demonstration has garnered widespread participation, with forty-five states, the District of Columbia, and two territories, American Samoa and the Commonwealth of Puerto Rico, receiving grant funding. This funding empowers these entities to strategize and implement MFP demonstrations. Further expanding its reach, in 2013, a Tribal Initiative was introduced, allocating funds to five MFP states. This initiative specifically targets partnerships with qualified Tribes and Tribal Organizations, aiming to develop culturally sensitive home and community-based services (HCBS) and reduce reliance on institutional care among Tribal members.
Core Financial Goals of the MFP Program
The MFP program is underpinned by several key objectives, all revolving around the strategic allocation and utilization of funds to reshape long-term care. These financial goals are explicitly designed to:
- Elevate the utilization of Home and Community-Based Services (HCBS) over Institutional Long-Term Services and Supports (LTSS) within Medicaid. This fundamental shift in resource allocation prioritizes community-based care models, recognizing their potential to offer more person-centered and often more cost-effective care solutions.
- Eliminate Financial and Regulatory Barriers Restricting Flexible Use of Medicaid Funds. The program directly tackles systemic impediments embedded in state laws, Medicaid plans, and budget structures. These barriers often hinder the adaptable deployment of Medicaid funds, preventing eligible individuals from accessing necessary LTSS in their preferred settings. MFP aims to dismantle these restrictions, promoting financial flexibility within the system.
- Enhance State Medicaid Programs’ Capacity to Guarantee Continuous HCBS Provision for Individuals Transitioning from Institutions. A critical financial aspect is ensuring the sustainability of community-based care. MFP strengthens the financial framework of state Medicaid programs, enabling them to reliably provide ongoing HCBS to individuals choosing to transition from institutional care settings to community living.
- Establish Robust Quality Assurance and Continuous Improvement Mechanisms for Medicaid HCBS. Financial investment in HCBS is coupled with a commitment to quality. MFP mandates the implementation of quality assurance procedures, at least on par with qualified HCBS programs. This includes financial support for continuous quality improvement initiatives within these services, ensuring beneficiaries receive high-standard care.
Cooperative Agreements: Defining the Funding Terms
The MFP demonstration operates through cooperative agreements, a specific type of financial award. Understanding the terms for money in this context requires differentiating cooperative agreements from standard grants. Cooperative agreements are characterized by “substantial involvement” between the federal awarding agency (CMS) and the recipient. This signifies a deeper, more collaborative financial partnership than a typical grant.
Under each MFP cooperative agreement, CMS actively participates in the activities of the award recipient. This partnership is not merely about disbursing funds; it involves joint effort and shared responsibility. CMS contributes through technical assistance, coordinates federal collaborations relevant to MFP demonstrations, conducts program evaluations, and engages in oversight and monitoring activities. These are all crucial elements that shape how the allocated money is utilized and managed.
Financial Impacts of MFP Implementation
The practical implementation of the Money Follows the Person (MFP) demonstration has yielded tangible results in transitioning individuals from institutional care to community living. Thousands of people with disabilities and older adults, eligible for Medicaid LTSS, have successfully moved from inpatient facilities to community-based settings thanks to MFP funding and program support.
The success stories emerging from MFP programs highlight effective strategies and financial resourcefulness in overcoming challenges. These programs innovate in several key areas, financially supported by MFP:
- Strategic Staffing for Community Transition: MFP funding enables the hiring of local staff embedded within inpatient facilities. These professionals provide crucial options counseling to residents, directly contributing to increased transitions to community settings. This targeted financial investment in personnel drives program outcomes.
- Upholding Quality Standards in HCBS: Financial resources are directed towards reinforcing high-quality standards for home and community-based services, both during the transition phase and in the long-term post-transition support. This ensures that the shift to community care is not only about location but also about maintaining and enhancing service quality.
- Investing in Essential Transition Costs: A significant aspect of MFP’s financial contribution is covering critical one-time transition expenses. This includes home accessibility modifications and the provision of necessary medical equipment. These direct financial outlays remove practical and financial barriers to community living.
- Optimizing Information Sharing for Enhanced Care: MFP supports improved information sharing systems, empowering transition specialists. By having better access to participant information, specialists can focus on understanding individual goals and preferences, leading to an improved experience of care. This investment in infrastructure indirectly enhances the financial efficiency of care delivery.
- Building Housing Partnerships: Addressing housing availability is crucial for successful community transitions. MFP encourages and supports the formation of strong partnerships with public housing authorities, state housing and health agencies, aging and disability networks, landlords, and developers. These collaborations aim to increase housing options for individuals transitioning to community care, often involving creative financial solutions and resource pooling.
- Tribal Initiative Advancement: Building upon existing relationships, MFP facilitates engagement with Tribal Nations to further the MFP Tribal Initiative. Financial and technical resources are directed towards culturally competent HCBS development within these communities.
Enhancing Quality: The Financial Dimension
Quality improvement is integral to the MFP program, and financial mechanisms are in place to support this. MFP grantees have considerable flexibility to integrate key HCBS system elements into their programs, strategies, and services. This includes financial allocations for processes and measures designed to enhance Medicaid HCBS quality.
CMS provides guidance for quality improvement through resources like the HCBS Quality Measure Set. This standardized set of measures helps states assess quality and outcomes within their HCBS programs, including MFP initiatives. CMS actively encourages states to utilize this measure set and is incorporating it into reporting requirements for MFP and other related programs, linking quality measurement to program accountability and potentially future funding considerations.
Navigating MFP Guidance and Specific Programs: Understanding Funding Streams
Within the broader MFP framework, several specific initiatives and funding opportunities exist, each with its own terms for money and objectives:
MFP Demonstration Expansion: New Funding Avenues
In 2022, CMS launched a Notice of Funding Opportunity (NOFO), allocating approximately $25 million in planning grants to five new states and territories. This expansion initiative aims to broaden access to home and community-based services (HBCS) through Medicaid’s MFP program. These planning grants provide crucial initial financial support for states embarking on the development and implementation phases of their MFP programs.
Changes to MFP Supplemental Services: Increased Federal Funding
Significant changes were announced regarding MFP “supplemental services” in March 2022. CMS increased the reimbursement rate for these services to 100% federal funding, eliminating the state share. Furthermore, the definition of supplemental services was broadened to encompass additional supports for community transition, such as short-term housing and food assistance. This enhanced federal financial commitment directly addresses barriers to community transition, aims to increase transition rates, and enhances the overall effectiveness of the MFP demonstration by providing more robust financial support.
MFP HCBS Capacity Building Initiative: Supplemental Funding for Transformation
In 2020, CMS announced a supplemental funding opportunity specifically for states already operating MFP transition programs. Up to $5 million in MFP grant funds was made available to each eligible state for capacity building activities. This funding is earmarked for accelerating LTSS system transformation and expanding HCBS capacity. This supplemental financial boost reinforces the focus on LTSS rebalancing and provides grantees with resources to make substantial progress in reshaping their long-term care systems.
The CMS Money Follows the Person Tribal Initiative: Dedicated Tribal Funding
The MFP Tribal Initiative (TI), initiated in 2013, dedicates funding to five state grantees to collaborate with tribal partners. This initiative is specifically designed to build sustainable home and community-based services tailored for Indian country. HCBS, crucial for enabling older adults and people with disabilities to remain in their homes, are made accessible through this initiative to individuals with functional limitations or cognitive impairments transitioning from institutional settings. Beyond service provision, MFP TI funding supports the development of the necessary infrastructure to implement HCBS within American Indian and Alaska Native (AI/AN) communities. This includes funding for planning and developing in-state Medicaid HCBS programs tailored for AI/AN populations and establishing service delivery structures that empower tribes or tribal organizations to manage and operate LTSS programs. MFP TI funds are intended to cover costs directly related to planning and implementing activities aligned with these objectives, under the overall terms and conditions of the MFP program.
Understanding the terms for money within the Money Follows the Person program is essential for stakeholders, policymakers, and individuals seeking to navigate the evolving landscape of long-term care. This multifaceted initiative utilizes various financial mechanisms – from cooperative agreements and grants to supplemental funding and dedicated initiatives – all aimed at fostering a more community-centric and person-directed approach to long-term services and supports. By strategically directing financial resources, MFP is driving systemic change and improving the lives of countless individuals.
