Money Follows the Person: New Jerseys Efforts in Rebalancing Long Term Care NASMD Fall Meeting Novem

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Money Follows the PersonNew Jerseys Efforts in
Rebalancing Long Term CareNASMD Fall
MeetingNovember 2008
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Presented byWilliam A. B. DittoDirectorNJ
Division of Disability Services609
292-7800William.Ditto_at_dhs.state.nj.us
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What is Money Follows the Person?

• MFP was initiated by the federal government to
  support people who want to move from an
  institution (either a nursing facility or a
  developmental center) to community-based settings
  
• It is a CMS demonstration project intended to
  assist states in rebalancing their Medicaid Long
  Term Care Systems
• New Jersey was one of the states selected by CMS
  for a multi-year grant

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Program Goals

• CMS has awarded MFP demonstration grants to
  assist states in
• Making services available in a manner that
  permits funding to follow the person to the
  most appropriate and preferred long-term care
  setting.
• Offering services to support individuals
  transitioning to community-based settings.
• Assessing the effects of the MFP program on
  Medicaid beneficiaries.

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Program Goals

• The key elements of MFP are
• Medicaid beneficiaries currently live in
  institutions want to live in the community.
• Caring for beneficiaries in the community is less
  costly than caring for them in institutions.
• Transitioning beneficiaries from institutions to
  communities will preserve their independence and
  ties to their community.

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New Jerseys MFP Application

• Collaborative unified application involving three
  state agencies
• NJ Division of Disability Services (DDS)
• NJ Division of Developmental Disabilities (DDD)
• Department of Human Services (state Medicaid
  agency)
• NJ Division of Aging and Community Services
• Department of Health Senior Services (DHSS)
• DDD is the lead agency for MFP in NJ
• To serve the elderly, people with physical
  disabilities and the developmentally disabled

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Part of a Bigger NJ Rebalancing Plan

• NJ has applied for, and received, a series of
  federal foundation grants to support
  rebalancing
• ADRC (CMS/AoA)
• Nursing Home Transition (CMS)
• Cash Counseling Research Demonstration (RWJ
  Foundation)
• Real Choice Systems Change Grant (CMS)
• Real Choice Systems Transformation Grant (CMS)
• Nursing Home Diversion (AoA)
• Money Follows the Person (CMS)

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Part of a Bigger NJ Rebalancing Plan

• NJ State Legislation
• Independence, Dignity Choice in Long Term Care
  Act (June 2006)
• Created a Medicaid LTC Funding Advisory Council
• Modeled on the ADRC pilots in New Jersey
• Directs the State Agencies and the State
  Treasurer to implement a process whereby
  increased funding is allocated to home
  community services
• Developed a program called Global Options (GO) to
  rebalance funding and offer greater choice
  control to consumers of LTC

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NJs MFP Plan

• Demonstration Period 5/14/07 to 9/30/11
• 5-Year Projected Transitions587 individuals
• 325 developmentally disabled individuals
• 175 older adults
• 89 physically disabled individuals
• Provides enhanced Federal Medicaid match of 75
  FMAP for one year post discharge from an
  institutional setting
• Total budget project is 48,915,863

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NJs MFP Services What does the State Get?

• Qualified HCBS 75 match
• MFP Demonstration Services 75 match
• Supplemental Demonstration Services 50 match

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Qualified HCBS Services (Waivers)
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MFP Demonstration Services

• Vehicle modification
• Peer Family Mentor
• Housing Specialist
• Job Development Specialist

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MFP Supplemental Demo Services

• Environmental Assessment for individuals with
  disabilities
• 1 time Groceries (transition)
• 1 time Clothing (transition)

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NJs MFP Who Qualifies?

• Qualified Individuals and Institutions
• Minimum residence in institution 6 months.
• 18 with developmental disabilities living in a
  State Developmental Center.
• 65 living in a Nursing Facility.
• 18 64 with a physical disability living in a
  Nursing Facility.

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Eligibility Requirements for MFP

• Consumers must choose to be in MFP
• Must have been in an institution for at least six
  months
• Must be on Medicaid for at least 30 days prior to
  discharge
• Must be willing to move to a qualified
  residential setting
• After the move, consumers must be willing to be
  interviewed and followed by program
  administrators to see how they are doing, ensure
  safety and learn from the experience to serve
  people even better in the future

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What qualifies in New Jersey as a community
setting for MFP?

• Qualified Community Residence
• A home owned or leased by the individual or the
  individual's family member
• An apartment with an individual lease, with
  lockable access and egress, and which includes
  living, sleeping, bathing, and cooking areas over
  which the individual or the individual's family
  has domain and control
• A residence, in a community-based residential
  setting, in which no more than 4 unrelated
  individuals reside.
• ASSISTED LIVING FACILITIES DO NOT QUALIFY FOR
  MFP!

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MFP Gives Consumers

• Participation in a program that supports people
  who prefer to live in community settings that
  allow more independence, opportunities to join in
  community life, and connections with friends and
  family
• Ability to help government agencies and service
  providers learn how to effectively serve
  individuals in the community

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How Will MFP Benefit the State?

• Provides increased Medicaid funds to support
  community transition activities.
• Medicaid match money from federal government is
  required to go back into state budget for home
  and community based services
• Its an opportunity to help build the long-term
  care system of the future where there is a
  greater emphasis on home and community based
  services

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MFP National Evaluation

• The study is being conducted to help states
  evaluate how well the MFP initiative is meeting
  the needs of beneficiaries and what changes may
  need to be made to improve the program.
• Collecting information on beneficiaries quality
  of life is of particular importance given that
  the purpose of the MFP initiative is to improve
  quality of life.
• Results will summarized in a report to Congress.

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What Were Some of the Issues for NJ in
Undertaking MFP

• MFP application process was daunting.
  Requirements for getting the Operational
  Protocol approved were complex.
• The issue of emergency back up systems and
  assuring health and safety proved difficult to
  address.
• Affordable housing is scare. The community
  service infrastructure is weak.

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Some Systemic Issues

• How will states continue when MFP ends?
• Enhanced match is available only for the first
  365 days after an individual leaves the
  institution, then the state has to have the money
  available to continue.
• The intent of MFP is positive, the reality is
  that community infrastructure has to be built and
  sustained for it to really work.

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Some Systemic Issues

• Are we RE-BALANCING or BALANCING?
• Is there still an institutional bias in the
  federal Medicaid program that impedes rebalancing
  in LTC?
• Under a new federal administration will we see
  continuation of these LTC initiatives?
• States are struggling with significant budget
  deficits will these programs survive?