The Success And Uncertain Future Of The Money Follows The Person Program

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Those in home-based care have seen a lot of government programs over the years, both good and bad. The Money Follows the Person (MFP) program tends to get brought up as part of the former camp – a good one.

The program was initially launched in 2007 and was funded by the Affordable Care Act through 2016. It has shown to be a successful way for seniors with disabilities to age in the comfort of their home as opposed to traditional, brick-and-mortar health care facilities.

The future of the program, however, is up in the air.

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“It’s been called for many, many times by our industry, and some members of Congress, to make the money permanent,” Darby Anderson, chief strategy officer at Addus Homecare Corp. (Nasdaq: ADUS), told Home Health Care News. “All around, it’s good for individuals’ quality of life and for their friends and family to have them back in the community. It’s good for the states from an economic cost of care perspective as well.”

In addition to his role at Addus, Anderson is also the vice chairman of the Partnership for Medicaid Home-Based Care.

The MFP program

The MFP “demonstration” began in 2007, and since then, the program has allowed more than 107,000 seniors and Medicaid beneficiaries to move out of institutional settings and back into their communities.

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Since 2016, legislators have made several attempts to reauthorize the program or lock in more permanent funding. Some of the attempts were through the Build Back Better Act and the Older Americans Act.

The program has had an up-and-down history because of the inconsistent funding that comes with it. In most cases, MFP has been a success when it comes to saving states money in Medicaid spending.

The height of the program came around 2017, according to Joe Caldwell, the director of the Community Living Policy Center at Brandeis University.

“At that time, there were 44 states participating, and we were seeing 10,000 transitions or so a year,” Caldwell told HHCN. “It took states a long time to ramp their programs up to get a good foundation and infrastructure in place, but they started to make really great progress.”

The short-term extensions given out by Congress hurt the program, Caldwell said. States started to drop out because of the funding uncertainty.

“There’s always been a question from the state’s perspective of, ‘How much do I commit to an infrastructure to really build a robust Money Follows the Person program if the feds can pull the funding at any time?’” Anderson said.

When states started to drop the program, transitions fell by nearly half. And then COVID-19 hit, which added more uncertainty.

MFP today

Within the last year, however, the Centers for Medicare & Medicaid Services (CMS) has slowly started to invest more into the program, signaling it has become a greater priority for the Biden administration.

In March, CMS announced a distribution of more than $110 million to expand access to home- and community-based services (HCBS) through MFP. Another $25 million came in August.

Anderson also pointed out one key change to the program, which broke down a significant barrier.

Previously, eligible seniors were able to transition back home if they were in an institution for six months or longer. Now, that waiting period is 90 days.

“When someone has been residing in a long-term care facility for six months or more, they’re so far away from that period of transition that sometimes their will to be back in the community can be dissipated,” Anderson said. “That’s helped a lot. But again, why 90 days? Why isn’t it 60 or 30 days? Why does there have to be any time at all?”

There’s also room for improvement within this waiting period.

Nearly every state has no presumptive eligibility for Medicaid-based home care, but they do for institutional care.

“At the time when an individual is at a hospital ready for discharge, they can presumably be eligible, under Medicaid, to go to a facility, but not to receive the same care in the home,” Anderson said. “They may be making that decision to go to the institution based on that. When they become eligible for Medicaid, oftentimes they’ll say, ‘Well, I could have gone home and stayed in the community, but now I’m stuck here for 90 days.’ Those two issues go together in some cases.”

Making sure patients have reliable housing and someone to keep them on track with medications are two of the main concerns for Anderson when it comes to the sustainability of the program in the future.

“Housing is always an issue,” he said. “If someone has been in an institution for a while and given up an apartment, a lease or sold their home, finding affordable housing has always been a challenge.”

Despite the lingering challenges, though, many in the industry believe in the long-term potential of MFP.

“It’s been as successful as it has because it’s very flexible,” Caldwell said. “The states get extra money from the federal government, and then they are allowed to spend that money pretty much on anything they want to, as long as it is related to home- and community-based services. That can be housing support, transition coordinators or other things that help out the states.”

The future of MFP

Last year, Congress extended MFP for three more years, giving states some certainty that it would be around until at least the end of 2023.

The extension was welcomed, but it still fell short of what most in the industry preferred.

“The best thing for Congress would just be to make the program permanent,” Caldwell said. “I think Congress knows that’s what needs to happen, now it’s just about coming up with the money and getting it through.”

Earmarking permanent funding for MFP would be a good first step, Anderson said. It wouldn’t be the only one.

“A concern I do have is that the success of individuals in the program does rely on the availability and consistency in care,” Anderson said. “From personal care services like Meals on Wheels to all the different HCBS services that might be out there with significant labor challenges that we have today, the amount of care that is going undelivered because of that workforce shortage is something I’m very concerned about.”

The American Rescue Plan Act funding that has been “propping up” many states and HCBS will soon run out, Anderson said.

When it does, grants from the federal government for programs like MFP could be on the chopping block.

“One of the things we’ve been working on at the Partnership for Medicaid Home-Based Care is really trying to close that gap to get an additional round of investments in HCBS services,” he said. “It has bipartisan support. A crucial element is making sure that we have the funding to provide additional services for folks to get them out of institutions. But if you don’t have the services to provide it, and you don’t have the availability of staff, then it’s not going to work.”

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