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

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


1
Money Follows the PersonNew Jerseys Efforts in
Rebalancing Long Term CareNASMD Fall
MeetingNovember 2008
2
Presented byWilliam A. B. DittoDirectorNJ
Division of Disability Services609
292-7800William.Ditto_at_dhs.state.nj.us
3
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

4
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.

5
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.

6
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

7
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)

8
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

9
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

10
NJs MFP Services What does the State Get?
  • Qualified HCBS 75 match
  • MFP Demonstration Services 75 match
  • Supplemental Demonstration Services 50 match

11
Qualified HCBS Services (Waivers)
12
MFP Demonstration Services
  • Vehicle modification
  • Peer Family Mentor
  • Housing Specialist
  • Job Development Specialist

13
MFP Supplemental Demo Services
  • Environmental Assessment for individuals with
    disabilities
  • 1 time Groceries (transition)
  • 1 time Clothing (transition)

14
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.

15
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

16
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!

17
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

18
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

19
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.

20
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.

21
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.

22
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?
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