HHS gives 13 states $45M for community-based long-term care options

Health and Human Services (HHS) Secretary Kathleen Sebelius announced Tuesday that 13 states have been awarded $45 million in new funds under the Affordable Care Act to assist Medicaid beneficiaries with moving out of institutions and into their own homes or other community settings.

The Affordable Care Act provides additional funding for two programs, the Money Follows the Person (MFP) demonstration program and the Community First Choice Option program. The MFP grants awarded Tuesday allow the thirteen states to start the program with a total of $621 million committed through 2016.

"Our country recognized in the Americans with Disabilities Act that everyone who can live at home or community-based setting should be allowed to do so," Sebelius said. "The Affordable Care Act provides states critical new dollars toward achieving that goal."

The MFP program provides individuals living in a nursing home or other institution new opportunities to live in the community with the services and supports they need. Groups benefiting from these home- and community-based programs include the elderly, persons with intellectual, developmental and/or physical disabilities, mental illness or those diagnosed with several of these conditions. To date, these programs have helped 12,000 individuals move out of institutions and back into their communities. The grants announced Tuesday are expected to help an additional 13,000 people.

"The Money Follows the Person program is hugely important to improving the lives of Medicaid beneficiaries," said Donald Berwick, MD, administrator of the Centers for Medicare & Medicaid Services (CMS), which will implement the demonstration program. "This helps bring everyone, even those who in the past may have had no choice but to live in an institution, into the community where they can become full participants in the activities most of us take for granted."

HHS has also proposed rules to allow all states to access a potential of $3.7 billion in increased federal funding to provide long-term services and supports through the Community First Choice (CFC) Option program.

The goal of CFC is to give states additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.

Starting in October, this option will allow states to receive a 6 percent increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid. Over the next three years – through 2014 – states could see a total of $3.7 billion in new funds to provide these services. States currently receive federal Medicaid matching funds for these activities at each state's normal matching rate.

Services and supports that can be provided under CFC include, but are not limited to, attendant services and supports that help individuals with activities of daily living such as bathing and eating, and health-related tasks through hands-on assistance or supervision. States may also cover costs related to moving individuals from an institution to the community, such as security and utility deposits, first month's rent, and purchasing basic household supplies.

To qualify for the increased federal funds, states must develop "person-centered plans" that allow the individual to determine how services are provided to achieve or maintain independence. States must also establish implementation councils with a majority membership consisting of persons with disabilities, elderly individuals and their representatives, to advise in the design and implementation of the Community First Choice Option. The proposed rule, posted Tuesday, describes the details of this program and solicits public comment. The rule can be found here.

"There is more evidence than ever that people who need long-term care prefer to live in their own homes and communities whenever possible," said Berwick. "To restrict these individuals to institutions where even the simplest decisions of the day such as when to get up, what to eat and when to sleep are made by someone else must no longer be the norm. This new federal funding will make a difference in people's lives."

See next page for list of 13 states receiving MFP grants.