1. 1 Michigan Nursing Facility Transitions/Money Follows the Person Grant October 2009 Michael Daeschlein, Manager, Home and Community- Based Services Section Ellen Speckman-Randall, Project Director, Nursing Facility Transition Program MDCH

2. 2 Nursing Facility Transition Program/ Money Follows the Person Goals: Eliminate barriers in policy and funding to enable individuals to receive long term care services in the setting of their choice. Increase the state’s ability to assure home and community-based services for individuals who transition from institutions. Ensure provision of quality assurance and continuous quality improvement in services. Support Olmstead decision

3. 3 Basic Principles of NFT Program: Everyone has the right to: Receive services in the most independent setting. Know their options for services & supports. Make informed decisions about options & risks. Control their own life. Have membership in a community. Receive high quality services as needed.

4. 4 MFP Grant: Federal Requirements, I. An MFP qualified transition candidate must: Have resided in an institution for at least 6 months. Have been receiving Medicaid for at least one month. Meet nursing facility level of care criteria.

5. 5 MFP Grant: Federal Requirements, II. An MFP participant must reside in a qualified residence including: A home owned or leased by the individual or a family member An apartment with an individual lease, lockable access, and living, sleeping, bathing and cooking areas over which the individual has control. A community residence with no more than 4 unrelated residents

6. 6 MFP Grant: National Evaluation, I. Under the grant, the federal government requires that many types of information be collected for people who transition with MFP funds so they can look at costs, quality of life issues, types of individuals who transition, and success of the program. 30 states have MFP grants so this massive amount of information will allow for a comprehensive look at transition issues and individuals who transition.

7. 7 MFP Benchmarks Michigan will transition 3,100 nursing facility residents into community living over the five years of the grant. There will be increased expenditures for community-based care each year of the grant. There will be an increased number of transitions per waiver agent each year of the grant. There will be increased use of self-determination by transitionees each year of the grant. Licensed settings will become a housing option for MI Choice recipients.

8. 8 Michigan’s Nursing Facility Transition Policy Supports transition services for Medicaid nursing facility residents who express a desire to move to a home & community setting, regardless of length of stay in the nursing facility. Covers transition costs to a home & community- based setting of the person’s choice, based upon a person-centered planning process. Assures needed services and supports are provided, based upon functional and financial eligibility.

9. 9 Post-transition Services Available to Transitionees MI Choice (an individual must receive MI Choice to be an MFP participant) Adult Home Help Hospice OSA Care Management Community Services Informal Supports, including assistance from family and friends

10. 10 Michigan’s Transition Partners 20 waiver agents which cover the entire state. Waiver agents can enroll transitionees in MI Choice, help them to access Adult Home Help, or link them with other community and informal options. 14 Centers for Independent Living (CILs) which cover most of the state. CILs can help transitionees access Adult Home Help, MI Choice or other community and informal options.

11. 11 Benefits of MI Choice Enrollment Higher income limit than other programs (300% of SSI, $2,022/month in 2009) Spousal asset protections Larger array of services than with other programs No waiting list for nursing facility residents Support coordination Person-centered planning Provider meet qualifications

12. 12 MI Choice Services Adult Day Health Chore Services Community Living Supports Counseling Home Modifications Fiscal Intermediary Goods & Services Home Delivered Meals Homemaker Non-Medical Transportation Personal Emergency Response System Personal Care Private Duty Nursing Respite Specialized DME/Supplies Training Residential Services

13. 13 Enrollment in MI Choice (eligibility) Medical/Functional Criteria Must meet nursing facility level of care Financial Criteria Unearned income less than $2,022/month Assets less than $2,000 countable Final determination is made by DHS Program Criteria Must need (and receive) at least one MI Choice service on a continual basis

14. 14 Plan of Care Development Use Person Centered Planning Must assure health and welfare at home Must address risk management issues The participant chooses who is included in the planning Must utilize informal supports and other funding sources before MI Choice services

15. 15 Determining the # of Hours Person Centered Planning Utilize informal supports first Utilize Medicare and other services first MI Choice fills in the gaps

16. 16 Benefits of Adult Home Help Program Person hires who they want to be their worker Less intrusive case management Less stringent qualifications (does not need to meet nursing facility level of care) Never a waiting list (unless waiting for an assessment from DHS) Only deal with one department - DHS No set upper income limit for income, but may have spend-down

17. 17 Home Help Services Personal Care Homemaking

18. 18 Nursing Facility Transition Data Number of transitions has grown over time Major barrier to transitioning nursing facility residents is lack of housing especially:  Barrier-free (wheel chair accessible)  Affordable (subsidized)  Housing for younger adults with disabilities  Housing for individuals with poor credit and/or criminal histories

19. 19 FY 2006 NF Transitions = 278

20. 20 FY 2007 NF Transitions - 455

21. 21 FY 2008 NF Transitions & Diversions 606

22. 22 FY 2009 - October thru August 25 NF Transitions & Diversions = 724

23. 23 Waiver Agent Codes A&D – A & D Home Health Care, Inc., Saginaw, MI AAA1B – Area Agency on Aging 1B, Southfield, MI AAANM – Area Agency on Aging of Northwest Michigan, Traverse City, MI AAAWM – Area Agency on Aging of Western MI, Grand Rapids, MI BB – Region 3B AAA @ Burnham Brook Center, Battle Creek DAAA – Detroit Area Agency on Aging, Detroit, MI HHS R8 – Health Options, Grand Rapids, MI HHS R14 – Health Options, Grand Rapids, MI MORC – Macomb Oakland Regional Center, Clinton Township, MI NMCSA – Northeast MI Community Service Agency, Inc., Alpena, MI NHCM – Northern Lakes Community Mental Health, Traverse City, MI R2 AAA – Region 2 Area Agency on Aging, Brooklyn, MI R4 AAA – Region 4 Area Agency on Aging, St. Joseph, MI R7 AAA – Region VII Area Agency on Aging, Bay City, MI SRRES – Senior Resources, Muskegon Heights, MI SRSVCS – Senior Services of Kalamazoo, Kalamazoo, MI TIC – The Information Center, Taylor, MI TSA – The Senior Alliance (AAA), Wayne, MI TCOA – Tri-County Office on Aging, Lansing, MI UPCAP – Upper Peninsula Area Agency on Aging, Escanaba, MI VAAA – Valley Area Agency on Aging, Flint, MI

24. 24

25. 25

26. 26 CIL Codes AACIL – Ann Arbor CIL BWCIL – Blue Water CIL CA – Capital Area CIL, Lansing CC – Community Connections DAKC – Disability Advocates of Kent County DCJ – disABILITY Connections, Jackson DC – Disability Connections, Muskegon DNOM – Disability Network Oakland & Macomb DNLS – Disability Network Lakeshore DNMM – Disability Network Mid-Michigan DNSW – Disability Network Southwest Michigan DNN – Disability Network Northern Michigan DNWC – Disability Network Wayne County SAIL – Superior Alliance for Independent Living TDN – The Disability Network, Flint

27. 27 FY ’09 (October 1 – August 25) Transitions by CIL = 142

28. 28 Michigan Medicaid Long Term Care Days

29. 29 Michigan Medicaid Cost Per Day for Long Term Care in FY 2008

30. CMS 6430 Long Term Care Spending in Michigan FY 2000 - 2008

31. 31 Contact Information Ellen Speckman-Randall, Nursing Facility Transition Project Director speckmane@michigan.gov 517-373-9532 (phone) 517-241-7816 (fax) Michael Daeschlein, Manager of Home & Community Based Waiver Section daeschleinm@michigan.gov 517-335-5322 (phone) 517-241-7816 (fax)