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Last Updated: 11/20/2017
 

Article of Interest - Medicaid

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Bridges4Kids LogoAdvice on Implementing a “Money Follows the Person” Program
Inclusion Research Institute, October 2004
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CMS issued another of its "Dear State Medicaid Director" letters (dated 8/17/04, SMDL #04-005). This letter is an important handle you can use to PERSUADE YOUR STATE Medicaid agency to move disabled persons into the community. This CMS letter will help you when your State agency offers excuses for why it cannot move disabled people into the community. CMS says it can move them into the community and can do it under existing rules!

CMS and Money Follows the Person - Information Bulletin # 73 9/04

CMS issued another of its "Dear State Medicaid Director" letters (dated 8/17/04, SMDL #04-005). This letter is an important handle you can use to PERSUADE YOUR STATE Medicaid agency to move disabled persons into the community. This CMS letter will help you when your State agency offers excuses for why it cannot move disabled people into the community. CMS says it can move them into the community and can do it under existing rules!!!!!

CMS has "supported states in implementation of the principles of money follows the person (MFP)... We are committed to continuing to assist states in implementing the principles of MFP UNDER EXISTING AUTHORITIES."

Money Follows the Person, CMS continues, is "a system of flexible financing for long-term services and supports that enables available funds to move with the individual.... It is a market-based approach that gives individuals more choice over the location and type of services they receive. A system in which money follows the person is also one that can
incorporate the philosophy of self-direction and individual control in state policies and programs."

CMS then discusses two critical issues that many State Medicaid directors use as excuses:

1. Waiver capacity and cost neutrality:

CMS says "States may request to amend their CURRENT HCBS waiver program to INCLUDE ADDITIONAL PARTICIPANTS.... Most states have found that in the AGGREGATE [not the individual-based cost neutrality] waiver programs continue to demonstrate cost neutrality even with the addition of waiver participants."

2. Backfilling of Nursing Home Beds:

"States that implement MFP strategies will begin to achieve a more equitable balance between the proportion of total Medicaid long-term support expenditures [in the community and institutions.] WE ENCOURAGE STATES TO REDUCE NURSING FACILITY BEDS TO ASSIST A STATE IN REBALANCING ITS LONG-TERM CARE SERVICES SYSTEM, but this is not a requirement."

What advocates should do:

1. This is only a CMS "Dear Medicaid Director" letter; nothing will happen unless you and other advocates use the CMS letter in yours struggles with your State Medicaid agency and your Governors. This CMS letter eliminates your States' excuses.

2. Make your States amend their waivers to make sure they are using the "aggregate" cost-neutrality basis.

3. Make your States reduce the number of nursing home beds. Nearly every state has an excess of beds. Get them off the books.

4. There should be NO WAITING LIST for waiver services. As CMS wrote, just have your state increase the number of participants in its waiver programs. This process is not difficult, nor is CMS the problem. Don't
take excuses from your State Medicaid agencies.

5. Has your State developed a Money Follows the Person program? Why not? After this CMS letter, what could be their excuses?

    

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