Medicaid broadens long-term care option
Georgia, like many states, is in the process of collecting data to show the results of its Money Follows the Person (MFP) program. "To date, 305 individuals left the nursing home and returned to the community," reports Alice Hogan, PMP, program director for Waiver Services at the Georgia Department of Community Health's Division of Medicaid, and acting project director for the state's MFP program.
Each of those individuals has completed a quality-of-life survey, designed by Cambridge, MA-based Mathematica Policy Research, prior to being discharged from the facility. This survey is completed again after the individual has been in the community for one year, and again at two years post-discharge.
Researchers at Georgia State University's Health Policy Center in Atlanta will be collecting and analyzing these data as they come in, along with cost data, service utilization, and other factors indicating program success.
"This spring, we have just reached our first large group of individuals who have completed the one year of participation in MFP. So, we have not yet had sufficient data to analyze," says Ms. Hogan. "We do expect to see that the cost to provide care for individuals is less in the community, and that they do have a better quality of life."
The program already has some anecdotal evidence to support that. "We have already heard from many of the one-year participants that the program has been instrumental in increasing their quality of life," says Ms. Hogan.
Georgia's program is expected to grow, in part due to the extension of MFP through 2016. "This will give us the time and funding to transition more individuals than originally planned," says Ms. Hogan. "We have expanded staffing in the state office to support this effort going forward." This includes a housing specialist position to make affordable, accessible housing available throughout the state.
Target correct individuals
A November 2009 Mathematica Policy Research report, Early Implementation Experiences of State MFP Programs, suggests there are a number of challenges facing states, including lack of affordable housing and worsening state budgets. This affects the state's ability to manage the program and build up capacity for home and community-based care services.
Almost 6,000 individuals had been transitioned through the program as of December 2009, according to a June 2010 letter from the Centers for Medicare & Medicaid Services (CMS) to state Medicaid directors. States currently in MFP have a goal of transitioning a total of 34,000 individuals by 2013.
"Mathematica's data showed that 2,790,000 people received long-term care services in institutions or in the community through Medicaid in the states participating in MFP," says Donna Folkemer, a group director at the National Conference of State Legislatures in Washington, DC, and former chief of policy and planning for the District of Columbia Medicaid Program.
"MFP is focused on a relatively narrow subset of Medicaid long-term care users. The key is to target the correct individuals," says Ms. Folkemer. She says that those individuals are people who want to leave facilities, can live successfully in the community with appropriate housing and services, and can make the transition only with MFP support.
"Careful evaluation of individuals in facilities, and careful attention to their needs after they leave, is essential," says Ms. Folkemer. "Nursing home residents are very heterogeneous. Many people come for short stays and leave on their own. Many others come at the very end of their lives."
Even among people who have been in the facility and on Medicaid for 180 days, which was the previous requirement, or for 90 days, which is the new requirement, Ms. Folkemer says that there is great diversity in family supports, ability to adapt emotionally and physically to a changed living arrangement, and many other things.
"MFP is all about choice for individuals. The benefits of the program will be individuals living and receiving services in settings that they prefer to nursing homes," says Ms. Folkemer.
As more individuals benefit from MFP, additional capacity may become available to support other persons with disabilities in the community. "In many ways, the expectation is that the financial support from MFP will help to build up an infrastructure that extends beyond MFP beneficiaries themselves," says Ms. Folkemer.
One of several strategies
MFP is only one of several strategies states are putting in place to support choice by individuals as to the setting in which they live and receive care. "MFP provides significant financial support for change, but it is focused only on one group of individuals with needs," says Ms. Folkemer.
The goal is for Medicaid to provide a better balance of long-term care options for individuals. Institutional services will become "less dominant, and part of a broader array of services available to persons with care needs," says Ms. Folkemer. "States have been working on this issue for at least a quarter of a century, through home and community-based services waivers and Medicaid state plan services."
The challenge is to find ways to reach the people most at risk of going to institutions, and then provide them with the necessary supports to avoid this.
"If the state wants to balance its long-term care service delivery system rather than just add more people to its system, it must make sure that it identifies individuals who don't want to enter a nursing home, but who are likely to enter one shortly and offer them services that can help them stay out," says Ms. Folkemer. "This is not an easy thing to do; I predict states will find better ways to identify those people."
Also, most Medicaid nursing home stays start with a Medicare-funded stay after a hospitalization. Therefore, finding ways to move individuals from hospitals to short-term nursing homes stays, and back to home, is important.
"This can't be done by Medicaid alone; Medicare and Medicaid will need to work together on this, and that's not easy either," says Ms. Folkemer. "There will be more attempts by states to make the Medicare/Medicaid funding and service delivery connections more productive."
Contact Ms. Folkemer at (202) 624-5400 or [email protected] and Ms. Hogan at (404) 657-5463 or [email protected].
Georgia, like many states, is in the process of collecting data to show the results of its Money Follows the Person (MFP) program. "To date, 305 individuals left the nursing home and returned to the community," reports Alice Hogan, PMP, program director for Waiver Services at the Georgia Department of Community Health's Division of Medicaid, and acting project director for the state's MFP program.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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