Maryland’s Money Follows the Person Rebalancing Demonstration Maryland Medicaid Advisory Committee Stacey Davis March 26, 2007

MFP Overview Created as part of the Deficit Reduction Act (2005) Maryland was among 17 states awarded funding in 2007 for this five year demonstration Intended to help states “rebalance” their long-term care systems  Serve more people in the community and fewer people in institutions

Demonstration Goals 1. Rebalancing – Increase the use of home and community-based, rather than institutional, long-term care services 2. Flexible funding – Eliminate barriers to the flexible use of Medicaid funds to provide eligible individuals support for long-term services in the setting of their choice 3. Sustainability – Ensure that long-term care services provided in a community setting are sustainable 4. Quality – Implement quality assurance and continuous quality improvement procedures for persons receiving home and community-based long-term care services

Maryland’s Proposed Transitions ** Only approximately 80 individuals are currently eligible to participate in the Demonstration, as the remainder have fewer than six months continuous residency. Total Proposed Demonstration Transitions: 3091 (Will change based on the approved Operational Protocol) Target Population Current Population Demonstration Transitions NF24,5312,741 ICF/MR Hospital 1,036** 25 IMD 80 75

Funding Initial award of $1 million for calendar year 2007 Projected 5 year award: $67,155,856 Enhanced match (75% Federal / 25% State) must be used towards demonstration goals and rebalancing  State will prioritize the use of funding during the development of the operational protocol  Stakeholders will be involved in developing priorities through workgroups

The MFP Program Creates a new program to offer enhanced services to individuals who transition from an institution to the community Eligibility for MFP  Six months in an institution, at least one month of Medicaid eligibility  Participants must transition from a qualified institution to a qualified community residence  Maximum of four unrelated individuals in a single residence

Timeline for Participants Day of Discharge 6 months 365 days day ? Mechanism MedicaidMoney Follows the Person Demonstration Existing or modified 1915(c) waiver Services Institutional Care Qualified Home and Community Based Services (HCBS) Package PLUS Demonstration Only Supplemental Services Qualified Home and Community Based Services (HCBS) Package Funding 50% MA / 50% FMAP 25% MA / 75% FMAP [HCBS] 50% MA / 50% FMAP [Admin] 100% MA [Supplemental] 50% MA / 50% FMAP After 365 days in demonstration, the qualified HCBS package must continue through a waiver or State Plan Amendment

Participating State Agencies Mental Health Administration Office of Health Care Quality Developmental Disabilities Administration Department of Aging Department of Disabilities Department of Human Resources Department of Housing and Community Development

Other Information UMBC will assist in the development of the operational protocol The State is required to hire a full-time project director The State will create a process for stakeholder participation in the development of the operational protocol