MFP Bills

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.

Money Follows the Person (MFP) Bills in the 116th Congress

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 is a crucial tool to help people in nursing homes and other congregate settings transition to smaller, safer settings in the community. However, Congress has so far only passed extensions providing short-term funding for MFP, the latest of which will expire on November 30, 2020 through a short-term extension of the Coronavirus Aid, Relief, and Economic Security (CARES) Act. Short-term MFP extensions are problematic because the lack of reliable funding for the program has caused states to significantly decrease the number of MFP transitions. 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 in May 2020, the COVID-19 epidemic caused Congress to put consideration of the PDPRA on hold.

Prior to the introduction of the updated PDPRA, on February 25, 2019, new versions of the EMPOWER Care Act extending the Money Follows the Person (MFP) program for five years were introduced in the House (H.R. 1342) and Senate (S. 548).

Call your Member of Congress and ask them to vote to permanently fund MFP, to help people with disabilities move out of nursing homes and other institutions and into the community. It is critical that Congress pass permanent funding for the program.

For more information, check out our fact sheet.

Short Term Extensions

On March 27, 2020, Congress included another short term reauthorization of the Money Follows the Person (MFP) program through November 30, 2020 as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act (H.R. 748).

On December 19, 2019, Congress approved a short-term reauthorization of the MFP program as part of the minibus spending bill. The deal reauthorized MFP through May 22, 2020. The reason Congress chose to pass a five month extension for MFP, HCBS spousal impoverishment protections, and several other extenders was to create pressure for a larger healthcare package before the Memorial Day recess that would include prescription drug pricing and surprise medical billing provisions. This aligned with the bipartisan proposal put forth by Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) earlier in December that included permanent reauthorizations of MFP and HCBS spousal impoverishment protections, which tied those reauthorizations to cost savings from its proposed prescription drug pricing provisions. Had Congress chosen to do a multi-year extension, that chance for permanent reauthorization of MFP in May would not have existed. Unfortunately, the COVID-19 epidemic caused Congress to put consideration of the bipartisan Grassley-Wyden proposal (including permanent reauthorization of MFP) on hold.

On August 6, 2019, President Trump signed into law the Sustaining Excellence in Medicaid Act of 2019 (H.R. 3253) which provides extensions of the MFP provision and the HCBS Spousal Impoverishment provision only until the end of 2019. H.R. 3253, originating in the House, was previously known as the Empowering Beneficiaries, Ensuring Access and Strengthening Accountability Act or the EMPOWER Care Act. In June, the House passed H.R. 3253 and the Senate took the House bill up at the end of July, passing an amendment in the nature of a substitute. This renamed the bill the “Sustaining Excellence in Medicaid Act of 2019” and changed the original proposed MFP and HCBS Spousal Impoverishment provisions.

On April 18, 2019, H.R. 1839, the Medicaid Services Investment and Accountability Act, became law. This bill added additional short-term funding to the MFP program (an additional $20 million for use by the end of September 2019) and extended the expiring spousal impoverishment protections for people receiving Home and Community Based Services also through September 2019.

On January 25, 2019, the Medicaid Extenders Act of 2019, a bill that included short-term funding for the Money Follows the Person program became law. The bill included three months of funding for MFP that states had until September 31, 2019 to spend. The bill also included an extension of the spousal impoverishment protections for people receiving home and community based services to March 31, 2019.

MFP Funding is Crucial to Help People Transition Back to the Community

First authorized by President Bush in 2005 with strong bipartisan support, MFP gets individuals with disabilities and seniors – if they wish – out of nursing homes and back into their communities. MFP has assisted more than 91,000 individuals voluntarily move into a setting of their choice, and has helped 44 states improve access to community-based long-term care, also known as “home and community-based services” (HCBS).

MFP Enhances Opportunities to Live Independently and Age with Dignity

Medicaid requires states to provide care in nursing homes, but HCBS is optional. MFP incentivizes investment in HCBS by providing federal funding for transitional services for individuals who wish to leave a nursing home or other institution. Thanks to MFP, over 91,000 seniors and people with chronic conditions and disabilities have voluntarily transitioned back into their communities.

MFP Rebalancing Demonstration is a Success Story that Improves Quality of Life and Care

At the end of 2015, nearly all states had an MFP demonstration. In a 2017 evaluation, the Centers for Medicare and Medicaid Services (CMS) found strong evidence that beneficiaries’ quality of life and care improves when they transition from institutional long-term care to HCBS. MFP participants experienced increases across all seven quality-of-life domains measured, and the improvements were largely sustained after two years.

States Save with Money Follows the Person

Providing long-term care in the home costs less than institutional care. Average monthly expenses for MFP participants declined by almost 25 percent in the first year after transitioning from a nursing home to HCBS. CMS also found that MFP participants are less likely to be readmitted to institutional care than other beneficiaries who transitioned but did not participate in the program.

States Need the Assurance of Permanent Funding of the MFP Program

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.