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Money Follows the Person: Expanding Options for Long-Term Care

Many Americans who need long-term care services and supports would prefer to receive them in home- and community-based settings rather than in institutions. Often, decisions relating to the provision of long-term care services are dictated by what is reimbursable under federal and state Medicaid policy rather than by what an individual needs.

The Money Follows the Person (MFP) Demonstration is the latest federal initiative to help states reduce their reliance on institutional care for people needing long-term care, and expand options for elderly people and individuals with disabilities to receive care in the community. With grants of $1.44 billion over five years, it is the largest demonstration program of its kind in the history of Medicaid. States use the grant funds to develop systems and services to help long-term residents of nursing facilities, intermediate care facilities for the mentally retarded, and psychiatric hospitals who want to move back to home or community-based settings. They also are increasing efforts to shift Medicaid long-term care spending permanently toward community-based care and services.

Mathematica's comprehensive five-year evaluation for the Centers for Medicare & Medicaid Services (CMS) is assessing how state long-term care systems change to support the transition of people from institutions to the community, whether the changes were successful and sustainable, and to what extent MFP helps rebalance state long-term care spending. The evaluation is also analyzing the effects of MFP on Medicaid beneficiaries' health and quality of life, as well as identifying characteristics of individuals and state programs strongly associated with success.

As part of the project, Mathematica is also providing technical assistance to CMS and to state grantees. To date, we have supported CMS review of the detailed operational plans each demonstration program developed and created a web-based semi-annual reporting system in collaboration with Thomson Healthcare. We are now monitoring grantee progress toward benchmarks. A series of short research reports is being produced each year, and a report to Congress will be submitted at the end of the evaluation.

Publications

“Early Implementation Experiences of State MFP Programs” Reports from the Field #3 (November 2009)
“Implications of State Program Features for Attaining MFP Transition Goals” Reports from the Field #2 (July 2009)
“Transitioning Medicaid Enrollees from Institutions to the Community: Number of People Eligible and Number of Transitions Targeted Under MFP” Reports from the Field #1 (January 2009)
"Research Design Report for the Evaluation of the Money Follows the Person (MFP) Grant Program" (October 2008)