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New Mathematica Report Profiles State “Money Follows the Person” Efforts
Contact: Cheryl Pedersen, (609) 275-2258
WASHINGTON, D.C. (July 13, 2009)—In 2007, the federal government funded programs in 30 states and the District of Columbia under the Money Follows the Person (MFP) demonstration to support the transition of Medicaid beneficiaries in long-term institutional care to home and community-based settings. A new report from Mathematica Policy Research, Inc., describes their experiences with transition programs and discusses how differences in key program features affect the pace and degree of implementation, as well as the likelihood of meeting transition goals.
States initially planned to move about 38,000 Medicaid-eligible people during the five-year demonstration period. Throughout 2007 and 2008, grantees began to implement programs to achieve their goals. Yet, by the end of 2008, only about 1,500 long-term care residents had returned to their communities, compared to the 4,250 transitions states had projected would take place. While some states are on track to meet transition goals, others have been slow to start programs, as a result of delays in securing federal approval of program plans or Medicaid policy changes, problems finding or contracting with transition agencies, and other setbacks.
Selected highlights from the report include the following:
- States that began the process with more transition experience and capacity are apt to implement programs faster and are better equipped to meet transition goals. Of the 30 grantees, 7 have substantial experience with operating transition programs, 13 have some experience, and 10 have little or no experience.
- Finding and securing affordable, accessible housing are key factors to success—as well as the most frequently cited barriers. States pursuing multiple strategies to increase the supply and access to housing may have greater success in the long run than those with limited approaches.
- To ensure that participants who make a successful transition can remain in their home or other community residence after one year of MFP eligibility, one-third of grantees need to make significant changes to Medicaid home- and community-based service (HCBS) policies or programs. Because they take significant time to bring about, states proposing new HCBS waiver programs or amendments to current programs, and those planning to add new options for consumers to direct their own services, are taking longer to begin transitions than states whose HCBS programs can accommodate MFP participants already.
“States that begin the program with little transition experience and those that experience delays still could achieve their transition goals by the end of the demonstration period once they resolve initial start-up problems,” said senior researcher Debra Lipson, lead author of the publication. “However, economic conditions and budgetary circumstances may affect implementation and grantees’ ability to attain transition targets, no matter how well the programs are designed and implemented.”
“Implications of State Program Features for Attaining MFP Transition Goals,” Reports from the Field No. 2, by Debra J. Lipson and Susan R. Williams is available at www.mathematica-mpr.com/publications/redirect_pubsdb.asp?strSite=pdfs/Health/MFPfieldrpt2.pdf. Subsequent reports in this series will compare the level of need and functional status of participants who transition to the community in each state with those who remain in institutions, and examine how states are using enhanced Medicaid matching funds generated by these transitions to improve their long-term care systems. The research was funded by the Centers for Medicare & Medicaid Services.
Mathematica, a nonpartisan research firm, conducts high-quality, objective policy research and surveys to improve public well-being. Its clients include federal and state governments, foundations, and private-sector and international organizations. The employee-owned company, with offices in Princeton, N.J., Ann Arbor, Mich., Cambridge, Mass., Chicago, Ill., Oakland, Calif., and Washington, D.C., has conducted some of the most important studies of health care, education, family support, employment, nutrition, and early childhood policies and programs.