on Implementing a “Money Follows the Person” Program
Inclusion Research Institute, October 2004
For more articles like this
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
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
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
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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