The U.S. Centers for Medicare & Medicaid Services (CMS) took a new step on Wednesday to support care transitions from long-term care facilities into home- and community-based settings.
On Wednesday, CMS announced the availability of up to $165 million in supplemental funding to states currently operating Money Follows the Person (MFP) demonstration programs. MFP programs allow certain Medicaid users, including older adults, to more seamlessly transition from a nursing home or institution back into the home, only if they desire to do so.
“The tragic devastation wrought by the Coronavirus on nursing home residents exposes America’s over-reliance on institutional long-term care facilities,” CMS Administrator Seema Verma said in the agency’s announcement. “Residential care will always be an essential part of the care continuum, but our goal must always be to give residents options that help keep our loved ones in their own homes and communities for as long as possible.”
CMS hopes the $165 million in supplemental funding will “jump-start” a nationwide migration away from nursing homes and long-term care facilities toward home-based care.
The MFP demonstration was established by Congress through Section 6071 of the Deficit Reduction Act of 2005. Programs officially launched in 2007, with more than 101,500 individuals using MFP to receive care in their own homes since.
“Home- and community-based care is not only frequently more cost effective, but is preferred by seniors and adults with disabilities seeking to maintain the dignity of independent living,” Verma said. “This new federal investment will help states get our loved ones back home.”
MFP Transitions as of Dec. 2019
Cumulative transitions under MFP in each state as of Dec, 31, 2019
The Partnership for Medicaid Home-Based Care (PMHC) has long advocated for continued and additional funding for MFP across the nation, according to Darby Anderson, who serves as vice chairman of the advocacy organization’s board.
PMHC sees MFP as a program that has proven its cost effectiveness and value year over year, he said.
“The Partnership for Medicaid Home-Based Care applauds CMS for the expansion of funding for MFP programs that allow older adults and people with disabilities the opportunity to return to their home and community,” Anderson told Home Health Care News in an email. “We also appreciate the supportive comments by Administrator Verma highlighting the benefits of home based care options.”
PMHC Chair Dave Totaro, who also serves as chief government affairs officer at Bayada Home Health Care, likewise voiced his support of the MFP move.
Totaro further highlighted MFP’s cost-savings potential as a major positive, as an internal Bayada study found that New Jersey alone could save approximately $30,000 per person annually if more care was provided in the home instead of facility-based institutions.
“My hope is that more policymakers recognize the savings delivered by home- and community-based services and implement policies to ensure greater access to high-quality, patient-centric, cost-effective home care,” he told HHCN in an email. “The more we invest in home care now, the more governments can save in the future by ensuring that their vulnerable populations are able to stay in the more cost-effective setting.”
Despite MFP’s popularity, utilization has declined over the past few years, federal statistics show.
In calendar year 2019, MFP grantee states transitioned a total of 4,173 Medicaid beneficiaries from long-term institutional care to home- and community-based care, down from 46% compared to 2018.
Texas and Ohio have recorded the most MFP-driven long-term care transitions since the program’s launch.
Overall, there are 33 states — plus the District of Columbia — that operate MFP-funded transition programs and plan to continue participating in MFP after this fiscal year. Only those Medicaid programs can receive access to the newly announced $165 million from CMS.
Each eligible Medicaid program can receive up to $5 million in supplemental funding for planning and capacity building activities to accelerate long-term care system transformation design and implementation. The money is also meant to generally expand home- and community-based care capacity, while supporting nursing home diversion strategies.
In theory, the funding could also be used to bolster the home-based care workforce. In its announcement, CMS officials noted that providers could use the funds for direct service worker recruitment, education, training, technical assistance and quality improvement activities.
Additional funding to support the direct care workforce is something PMHC has been calling for since May.
PMHC has also called for presumptive eligibility in home care, which would drastically streamline the process for initiative Medicaid-reimbursed home care services.
“We will continue to advocate for advances in MFP and also promote presumptive eligibility in all states in order to improve accessibility to home- and community-based care to all that need these services,” Anderson said.
Several lawmakers have backed MFP over the years, including U.S. Rep. Debbie Dingell, a Michigan Democrat. Dingell was among the members of Congress to push for an MFP funding boost last year.
“The long-term care system in this country is broken,” the representative said at the time. “Seniors, families, and caregivers are often desperate, stressed, and don’t know where to turn.”