Money Follows the Person

Update: December 22, 2020

Late last night, Congress passed the Consolidated Appropriations Act, which includes both general government funding and coronavirus relief provisions.

The COVID-19 relief provisions do not include dedicated funding for home and community-based services (HCBS) that is urgently needed. Additional stimulus checks are also provided, but adults with disabilities who qualify as dependents are again unfairly excluded.

The bill does, however, extend funding for the Money Follows the Person (MFP) program for three years, along with spousal impoverishment protections. While this is not the permanent funding we have been advocating for, it is a good start, and we will continue advocating for permanent funding for this critical program.

More on the priorities that did and didn’t make it into the bill can be found here. You can find additional section-by-section summaries of the bill and one page summaries here.

A comparison of the Consolidated Appropriations Act and other recent coronavirus relief proposals can be found here.

For more information on why funding MFP matters, check out our fact sheet.

Take Action and Urge Congress to Permanently Fund MFP!

Permanent funding for MFP is a critical solution to the COVID-19 crisis in nursing homes and other congregate settings. Over 40% of COVID-19 deaths to date have been related to nursing homes, with even higher rates of infection. MFP, along with increased funding for Medicaid home and community-based services (HCBS), are crucial tools to help people in nursing homes and other congregate settings transition to smaller, safer settings in the community.

Congress has passed five short-term extensions of MFP since funding expired in 2018. The lack of reliable funding has caused states to significantly decrease the number of transitions under this program, with a more than 50% decrease between June 2018 and July 2019. A number of states have completely shut down their MFP programs or are in the process of doing so.

On December 6, 2019, Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) announced that permanent extensions of the MFP program and protections against spousal impoverishment for recipients of Medicaid Home and Community Based Services (HCBS) would be included in the updated version of their bipartisan drug pricing legislation, the Prescription Drug Pricing Reduction Act (PDPRA) of 2019, introduced earlier in 2019. The updated legislation would provide funding to states to continue efforts to transition people with disabilities and older adults from institutions back into their communities through the MFP program. Although Congress initially appeared likely to take up the PDPRA as part of a larger healthcare package in May 2020, the COVID-19 epidemic caused Congress to put consideration of the PDPRA on hold.

The MFP Program has helped more than 91,000 seniors and people with disabilities move out of nursing homes and other institutions and into the community. MFP has improved the lives of older adults and people with disabilities, saved states money, and led to better outcomes. That’s why nearly every state has participated in the program.

We will continue in our work to make this vital program permanent and hope you will join us!

Stories

The Money Follows the Person (MFP) Demonstration – first authorized in the Deficit Reduction Act of 2005 with strong bipartisan support and signed into law by President Bush – was designed to assist states with: (1) supporting Medicaid enrollees who want to transition from nursing facilities back to community-based settings; and (2) developing infrastructure to promote and enhance access to HCBS.

Impact of Money Follows the Person

Since its inception, 44 states have participated and over 91,000 individuals have been transitioned back to the community.
According to independent evaluations by Mathematica:
- Participants report significant and lasting improvements in quality of life and community integration after returning to the community.
- Findings suggest that after individuals return to the community, their overall Medicare and Medicaid expenditures decrease by roughly 20%.
States have made significant progress on “balancing” their long-term services and supports system to enhance access for HCBS, due in part to MFP. In FY05, states only spent approximately 37% of their LTSS expenditures on HCBS. According to the most recent data, states now spend approximately 57% on HCBS.

Need to Continue

While states have made progress, more work is needed. Significant variations remain across states and different populations who need HCBS. For example, HCBS accounted for 78% of spending in programs targeting people with developmental disabilities, compared to only 45% of expenditures for programs supporting older people and people with physical disabilities and 46% for behavioral health services provided to people with mental health and substance use disorders.
Over 50,000 nursing home residents said they wanted to talk with someone about leaving their facility, but never received a referral to a local agency that could help them, according to analyses of Nursing Home Minimum Data Set reporting.
States have learned lessons and can share promising practices with other states.