The Last Word: Uncertain Prospect — Will Congress Continue the Money Follows the Person Program?
Money Follows the Person (MFP), a federal program launched in 2007, allocated $1.75 billion over five years to fund state programs to transition participants from skilled nursing facilities (SNFs) to home- and community-based services (HCBS). In 2011, Congress extended the program and increased the allocation to $4 billion. Forty-four states and the District of Columbia participate in the program, and, as of 2018, there have been more than 88,000 transitions. MFP is the largest demonstration program in the history of Medicaid.
MFP expired in 2016, and while states can still continue to access funding through fiscal year 2021, many states have already exhausted their funding allotments. Earlier this year, Congress provided short-term funding to extend the program, but those monies are expected to run out by fall 2019. Pending in Congress is the EMPOWER Act, a bill that would strengthen MFP and extend the funding until 2023. However, despite its bipartisan support, the final outcome of the bill is uncertain.
HCBS is far more affordable to SNFs than long-term support and services (LTSS) Medicaid payments. According to the Center on Budget and Policy Priorities, from 2008 to 2013, MFP saved more than $978 million in Medicare and Medicaid funds and has played a significant role in states’ LTSS rebalancing programs. Findings suggest those who participate with MFP lower Medicare and Medicaid expenditures by 20%.
Recent evaluations show MFP has many positive outcomes: Early access to HCBS minimizes the length of institutional stay, beneficiaries are three times more likely to return to the community after an institutional stay (compared with SNF residents on LTSS), and participants have a much lower SNF readmission rate after their initial discharge to the community from the SNF.
MFP has also improved quality-of-life outcomes for participants. Of those surveyed, 92% report they liked the place they lived after one year of transitioning to the community—a 30-point increase when compared with surveys of SNF residents on LTSS.
MFP programs also generated an 18–percentage point decline in barriers for participants transitioning from SNFs to community-based care settings and resulted in less depression for participants as compared with SNF residents on LTSS.
Significant variations for populations that need HCBS exist from state to state. For example, HCBS accounted for 75% for persons with developmental disabilities when compared with 41% expenditures for the elderly, people with physical disabilities, and people with serious mental illness.
Most MFP participants are young (more than 62%), even though the majority of MFP-eligible candidates are older than 65 and reside in SNFs. Relatively few older adults participate with MFP when the overall eligible population is considered; for every 1,000 seniors eligible, there are only three SNF transitions.
States experience significant challenges when implementing MFP, including housing shortages, limited HCBS capacity, shortages of direct-care providers, and inefficient Medicaid policies. Despite these handicaps, MFP is popular, and many SNF patients could benefit. In a recent analysis of Minimum Data Set reporting, more than 50,000 SNF residents said they wanted to speak with someone about leaving the facility.
It’s up to Congress and the President to sign into law the bill titled the EMPOWER Act to extend MFP until 2023. A bill that saves money and allows patients to transition out of SNFs should have swift passage but, like many things in Washington, even the most commonsense of proposals face tough odds when fickle political winds blow without rhyme or reason and good ideas, like doomed sailing ships, lie broken against the shore.
— Jason Bloome is owner of Connections–Care Home Referrals, an information and referral agency for care homes for the elder population in Southern California (www.carehomefinders.com).