Obamacare and the Money Follows the Person Program

 May 9, 2013
Posted by M&LAdmin4

Thursday, May 9th, 2013

A few weeks ago, M&L Special Needs Planning, LLC posted a blog titled “Back to Basics: Obamacare for Individuals with Disabilities”. In this blog, we briefly outlined the various changes taking place to the health care system under the Affordable Care Act, with a focus on the reforms that we felt were particularly beneficial to individuals and families with special needs. One of these reforms included the expansion of Medicaid and, in turn, the expansion and extension of the Money Follows the Person program.

In case you aren’t familiar with this program, it was introduced as a “Rebalancing Demonstration Program” under the Deficit Reduction Act of 2005. The program, which was given up to 1.75 billion and slated to run until the end of the 2011 fiscal year, was designed to help States shift Medicaid’s long-term care spending from institutional care to home and community based services[i]. Essentially, the Money Follows the Person program provides funding to help States with the process of transitioning Medicaid recipients – such as individuals with disabilities, or elders requiring long term care – from institutional settings into community settings.

As mentioned, the Affordable Care Act of 2010 both extended and expanded the program. In a letter written by the Center for Medicaid and Medicaid Services, the expansion and extension “provides an opportunity for those states that are presently participating in the program to continue building and strengthening their MFP [Money Follows the Person] Demonstration Programs, and for additional states to participate.[ii]” An additional 2.25 billion federal dollars were appropriated for the program, and it was extended it from its original termination date (the end of the 2011 fiscal year) to the end of the 2016 fiscal year. A number of other changes were made as well, including the allocation of extra funds for research and evaluation of the program. The Act also changed the eligibility requirements of the program – the original requirements stated that applicants must have had a six month (consecutive) stay in an institution in order to be eligible; under the Act the minimum stay has been reduced to 90 consecutive days. This change is perhaps the most important to the special needs community, as it significantly widened the applicant pool.

How does the Money Follows the Person Program work?

Many people who currently receive long term care would prefer to receive these supports in home and community settings rather than in institutional settings. Often, however, the decisions regarding long term care are influenced by federal and state Medicaid policy – as States have traditionally relied on institutional settings to deliver these services, many people find themselves forced to turn to institutional settings to receive long term care. The primary purpose of the Money Follows the Person program is to change this state reliance on institutions, and help those who currently receive long term care to make the decision as to where they would like to receive those services and supports. States who participate in the program receive grants to develop programs and systems to deliver these services and supports outside of institutions and to improve home and community based services. This reduced reliance on institutional settings, and increased use of home and community based services is one of the four program goals identified on the Medicaid.gov website. The program also intends to eliminate barriers in State law, Medicaid plans, and budgets that restrict the use of Medicaid funds for those who want to choose where to get long term care, to strengthen the ability of Medicaid programs to provide home and community based services to those who wish to leave institutional settings, and to offer quality assurance for the home and community based long term care services being offered.[iii]

Program Eligibility Requirements

Currently, 45 states and the District of Columbia participate in the program (note: see endnote 4[iv] for a list of participating states). Each state administers its own Money Follows the Person program, with federal funding. Individuals should review the program objectives, qualifications and goals that are pertinent to their home state; a Google search will reveal the programs in each state. In Washington, D.C., for example the program is available to “individuals with intellectual disabilities residing in long-term care settings, such as Intermediate Care Facilities for Persons with Intellectual Disabilities (ICF/ID), who are eligible for the DDA Home and Community Based Services (DDA HCBS) waiver, and individuals living in nursing facilities, who are eligible for assistance through the Elderly and Physical Disability (EPD) Home and Community-Based Services waiver.[v] In order to qualify for the program, an applicant must have stayed in an institution for a minimum of 90 consecutive days, been supported by Medicaid to stay in a long-term care facility for 30 days, be interested in receiving services and supports in the community, and be eligible for one of D.C.’s Medicaid Home and Community Based Services Waiver Programs.

If you have any questions about the Money Follows the Person program, or any other government benefit program, please contact us! We are always happy to help. You may also wish to have a look at our Understanding SSI/Medicaid & SSDI/Medicare workshop, which we offer free of charge at various locations and times throughout the year.

Thanks for taking the time to drop by our blog this week; have a great day!


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