Medicaid, Money Follows the Person, and the Community Choice Act
Author: Wendy Taormina-Weiss
Synopsis and Key Points:
Money Follows the Person is an initiative program giving people the freedom to choose and take advantage of opportunities in America.
Main DigestIn America today people who rely upon Medicaid for health care coverage are fighting for the programs that enable them to remain in their own communities and receive the health care they need. The people I am referring to are not only those who experience forms of disabilities from birth; disability can affect anyone at any point during their lifetime. Every single day in America, people experience everything from motor vehicle accidents to work-related accidents that find them with injuries serious enough they require assistance from the state through Medicaid.
Money Follows the Person - The "Money Follows the Person" Re-balancing Demonstration Program (MFP) helps States re-balance their long-term care systems to transition people with Medicaid from institutions to the community. Forty-three States and the District of Columbia have implemented MFP Programs. States participating in MFP are: AR, CA CO, CT, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, TN, TX, VA, VT, WA, WI, WV and the District of Columbia.
Two of the things people are fighting for in relation to Medicaid include, 'Money Follows the Person,' and the Community Choice Act. Perhaps the most vocal of the groups fighting for these things is ADAPT. The voices of ADAPT members are up against a Republican Congress that controls the budget strings, so to speak, as well as those who put money before health care during a time of national financial strife.
One of the most basic facts about health care is that everyone in the world needs it; able-bodied or not. Health care also does not simply stop based upon the economy; health care is something that continues on a 24/7 basis. The provision of health care, as well as the settings in which it is provided, cannot be based upon monetary perspectives - health care is a human right.
What is, 'Money Follows the Person'
The, 'Money Follows the Person,' is an initiative; one that is a part of former President Bush's proposal for a Money Follows the Person Program. The program gives people the freedom to choose where they want to live, allowing them to take advantage of opportunities others in America take for granted such as:
- When they want to go to bed
- The opportunity to have a job
- When they want to go outside
- What and when they want to eat
- When they want to visit with family members or friends
- The opportunity to participate in their own communities
Money Follows the Person is a win-win because people with disabilities receive the opportunity to live in their own communities, while states in America receive the resources they need to re-balance their long-term services systems and increase the availability of their community-based services. The Olmstead decision, through the Supreme Court, said that needlessly institutionalizing people with disabilities is discrimination under the Americans with Disabilities Act (ADA), and the Money Follows the Person initiative helps states to comply with both the ADA and the Olmstead decision.
The states in America are dealing with major budgetary shortfalls and major Medicaid cuts at the federal level are involved in the majority; if not every, state in this nation. One of the largest barriers to compliance with the ADA and the Olmstead decision is funding, to be plain. As the states in America work to deal with their budgets and restrict spending they must also fund nursing homes, which are entitlement. States have to fund nursing home services with a minimum of dollars - they are looking towards community services to stay at the same level of funding or lower.
The Money Follows the Person initiative has some important benefits, to include:
The Cost: The cost of providing care in a person's own community is approximately two-thirds the cost of the same care in a nursing home or another equivalent type of institution.
No, 'Bumping': No more, 'bumping,' people on waiting lists - Money Follows the Person uses funds which pay the person in the nursing home or other type of institution; not waiver funds.
No 'Backfill': 'Backfill,' or woodwork because nursing homes are an entitlement will not exist; there are no waiting lists for nursing homes. 'ICFs-MR (persons with mental retardation)', for example, can simply close the beds once the people have left.
The Community Choice Act (CCA)
The Community Choice Act is an exceptionally important Act - it gives people real choice in relation to long-term care options by reforming Title XIX of the Social Security Act (Medicaid) and ends institutional bias. The CCA permits people who are eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded (ICF-MR) the ability to choose the alternative of, 'Community-based Attendant Services and Supports.'
Yes - The Money Follows the Person. What; specifically, does the CCA do for people with disabilitiesWell...a number of things such as:
Quality Assurance Programs: The CCA provides for quality assurance programs; ones which promote consumer satisfaction and control.
Hands-on Assistance: As well as supervision or, 'queuing,' assistance with learning, and maintaining and enhancing skills in order to accomplish these activities.
Enhanced Funds Matching: The CCA allows for enhanced match, up to 90% of federal funding, for people whose costs exceed 150% of the average costs of a nursing home.
Income Waiver: The CCA serves people whose incomes are above the current institutional income limitation; if a state chooses to waive the limitation in order to enhance employment potential.
Personal Attendants: The CCA permits tasks or health-related functions to be delegated to, assigned to, or otherwise performed by, personal attendants who are unlicensed in accordance with state laws.
Effort Maintenance Provision: The CCA provides for maintenance of effort assurance requirement, so states may not diminish more enriched programs that are already being provided to people with disabilities.
Option to Choose an Individual Representative: For people with disabilities who are not able to direct their own care independently, the CCA allows them to authorize an individual representative such as a family member, friend, guardian, or advocate.
Choice of Service Delivery Models: The CCA allows people with disabilities, as consumers, to choose among different service delivery models - to include direct cash payments, vouchers, agency providers, and fiscal agents. All of these models are controlled by the consumer.
Coverage of Transition Costs: The CCA covers the individual transition costs of moving from a nursing facility or ICF-MR to a person's home setting. Examples of these costs include things such as rent and utility deposits, basic kitchen supplies, bedding, as well as other needed items for the person's transition.
Provision of Community-based Attendant Services and Supports: These services and supports provide assistance with activities of daily living such as toileting, bathing, transferring, dressing, grooming, and eating. They also provide services and supports with instrumental activities of daily living such as meal planning and preparation, shopping, using the telephone, household chores, managing finances, health functions, and community participation.
Through the Community Choice Act, people with disabilities can receive Attendant Services and supports that are:
- Based upon functional needs instead of their age or diagnosis
- Provided in accordance with a service plan agreed to by the person
- Supplemented with both backup and emergency attendant services
- Includes voluntary training regarding the selection, management, and dismissal of attendants
- Selected, managed, and controlled by the person with a disability, who is a consumer of the services
- Provided in their home or in community settings such as work, school, religious facilities, or recreation
The Community Choice Act provides grants for Systems Change Initiatives with the goal of helping states to transition from their current, institutionally-dominated service systems to ones that are focused on community-based services and supports. The initiatives are guided by a Consumer Task Force. The CCA requires services and supports for people with disabilities to be provided in the most integrated setting appropriate to meet the needs of the individual.
The United States of America is experiencing rough financial times, no questions about it. Disability is also a fact of life; so is the human right and need for health care - something that does not recognize the economy. The Americans with Disabilities Act is law, and the Supreme Court of this nation has stated that unnecessary institutionalization of people with disabilities is discrimination.
The Community Choice Act and Money Follows the Person are two very clear solutions to the issues facing America in relation to people with disabilities and the provision of health care. Providing health care in our own communities for people with disabilities costs around two-thirds of what it does to do so for the same people in nursing homes or similar institutions. America cannot afford to continue institutionalizing people with disabilities, and the Medicaid programs that we need must not be destroyed by politicians. Failure to pursue the Community Choice Act, Money Follows the Person, and support of Medicaid and Medicare is equivalent to disability discrimination and failure to recognize our human right to health care.
Money Follows the Person (MFP)
"From spring 2008 through December 2010, nearly 12,000 people have transitioned back into the community through MFP Programs. The Affordable Care Act of 2010 strengthens and expands the "Money Follows the Person" Program to more States."
Medicaid Savings Proposals
"Studies have demonstrated that by reducing the over-reliance on institutions and nursing facilities and shifting toward more cost-effective community-based services, states can contain Medicaid spending."
Community Choice Act (CCA)
"For decades, people with disabilities, both old and young, have wanted alternatives to nursing homes and other institutions when they need long term services. Our long term care system has a heavy institutional bias."
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