Impact of the Money Follows the Person Program July 25, 2019 - PowerPoint PPT Presentation

Impact of the Money Follows the Person Program July 25, 2019

Community Living Policy Center • Aims to advance policies and practices that promote community living outcomes for individuals with disabilities of all ages through research and knowledge translation. • The CLPC received support from the National Institute for Disability, Independent Living, and Rehabilitation Research (NIDILRR) within the Administration for Community Living, U.S. Department of Health and Human Services (Grant # 90RTCP0004). The contents of this webinar do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the Federal Government.

Community Living Policy Center Partners • Lurie Institute for Disability Policy at Brandeis University • University of California, San Francisco (UCSF) • Association of University Centers on Disabilities (AUCD) • Autistic Self Advocacy Network (ASAN) • Disability Rights Education & Defense Fund (DREDF) • Disability Policy Consortium (DPC) • Centene Corporation • National Association of States United for Aging and Disabilities (NASUAD) • Mike Oxford, Topeka Independent Living Resource Center • Henry Claypool, National Policy Expert • Disability and Aging Collaborative

Webinar Logistics • The power point and archived recording will be available on the Community Living Policy Center website: • www.communitylivingpolicy.org • Webinar is being live captioned • Time for questions following speakers • Submit questions via the Chat function

Presenters Carol Irvin Mathematica Steve Kaye University of California San Francisco Nicole Jorwic The Arc of the United States

The Cost Savings and Quality of Life Implications of the Money Follows the Person Demonstration Carol V. Irvin July 25, 2019

Money Follows the Person (MFP) Rebalancing Demonstration • Prin incip ipal A l Aim ims • Reduce reliance on institutional care • Develop community-based long-term care opportunities • Enable people with disabilities to participate fully in their communities and improve their quality of life 7

Legislative History • Established ed b by Deficit R Reduction A Act o of 2 2005 5-year demonstration and $2 billion in grant funding for states • • Exten tended ed and e expanded ed b by the A e Affordable e Care A e Act o of 2 2010 • 5-year extension and additional $2 billion in grant funds • Exten tended ed by the M e Medicaid E Exten tender ers A Act o of 2 2019 Added $112 million for federal fiscal year 2019 • 8

A Popular Demonstration... WA MT ME ND MN OR VT ID NH MI WI NY MA SD RI WY CT PA IA NJ NE OH MD DE UT NV IN IL WV CA CO VA KS MO KY State with MFP NC TN program OK AZ NM AR SC No MFP program GA AL MS in state TX LA AK FL HI 9

...Sizeable Eligible Population... More Than One Million Eligible for MFP In Any Given Year 1,400,000 1,221,024 1,147,364 1,200,000 1,084,786 1,000,000 Number of Individuals 800,000 600,000 400,000 200,000 - 2006 2007 2008 2009 2010 2011 2012 2013 2014 Older adults Physical disabilities Intellectual disabilities Total Source: Mathematica analysis of Medicaid Analytic eXtract (MAX) data from 2006 through 2014. 10

...But Not a Large Demonstration Total cumulative number of MFP transitions grew steadily from 2008 through 2015 70 63,337 63, 337 60 51, 51,676 676 50 40,693 40, 693 40 Thousands 30, 30,141 141 30 19,728 19, 728 20 673 11,924 924 473 5, 5,67 10 1,473 1, 0 De Dec Dec De De Dec De Dec Dec De Dec De Dec De Dec De 2008 20 08 20 2009 09 2010 20 10 2011 20 11 20 2012 12 2013 20 13 2014 20 14 20 2015 15 Source: Mathematica analysis of MFP enrollment records submitted by states to CMS. 11

Community-Based Services Are Less Costly than Institutional Care • Average per-beneficiary-per-month (PBPM) Older adults expenditures declined by $1,840 (23 percent) • Average PBPM expenditures declined by People with physical disabilities $1,730 (23 percent) People with • Average PBPM expenditures declined by intellectual/developmental $4,013 (30 percent) disabilities 12

Savings Were Accrued by Medicaid • MFP p participants ts ge gener erated to total s savings gs o of $ $978 m million in me medic ical a al and L LTSS c cos osts • $1 billion in savings to Medicaid • $25 million increase to Medicare because of gains in Medicare coverage during the first year 13

Assessing Costs Extremely Difficult— Could Not Assess All Costs • Housing g – room oom a and b boar ard • Costs b beyond the f e first y t year a aft fter t the t transiti tion • Attempted to look at costs two years post transition, but results were inconclusive 14

Changes in Costs Not Unique to MFP • The d e dec ecline i in costs o observed a among M MFP p parti ticipants i is similar to wh what w t we s e see ee for others wh who t transiti tion o outs tside t the d e dem emonstration • Did MFP transition b benefi ficiaries es w who w would not h have t e transitioned ed o other erwi wise? e? • Never detected a robust increase in transitions after MFP began MFP participants had characteristics that suggested they had fewer connections to the • community 15

Other Avenues for Cost Savings • Did MFP hel elp b ben eneficiaries r rem emain l longer i in the c e community ty? • Did MFP reduce the likelihood of someone returning to facility level care? • When someone returns to a facility, is the stay shorter because of MFP? • Did M MFP p provide m e more e access to to medical c care? e? • If MFP provides higher quality HCBS, are medical care costs lower as a result? 16

MFP Provided Other Benefits Supported infrastructure changes • Helped states establish formal transition programs Stronger State LTSS Systems • Catalyst to interagency collaboration between health and housing • Improved access to community-based LTSS 17

Invaluable Quality of Life Improvements 92.4 100 92.4 91.8 91.4 91.3 91.0 83.5 83.1 79.6 76.8 80 Percentage 66.2 61.9 60 51.8 46.0 38.7 36.6 34.0 40 29.8 18.3 20 7.6 6.3 0 Overall life Depressive Satisfaction Any unmet Respect and Satisfaction Barriers to satisfaction symptoms (a) with care need for dignity with living community personal care arrangements integration (a,b) (a,c) Pre-transition One year post-transition Two years post-transition Source: Mathematica’s analysis of MFP QoL surveys and program participation data submitted to CMS through May 2016. Note: The analyses are based on surveys from 13,795 MFP participants. All post-transition results were statistically different from pre-transition results at the .01 level, two-tailed test. a A declining percentage indicates improvement in depressive symptoms, or fewer unmet needs, or fewer barriers to community integration. b Measured as “Any unmet need for personal assistance services” in bathing, eating, medication management, and toileting. c Measured as affirmative responses to the question: “Is there anything you want to do outside [the facility/your home] that you cannot do now?” 18

Unmet Needs Declined Post Transition 20.0 18.3 18.0 16.0 14.0 12.0 10.8 Percentage 10.0 8.0 7.6 8.0 6.0 4.1 4.0 2.7 2.6 1.6 1.5 1.4 2.0 0.0 Any unmet care need Bathing Meals Medications Toileting Pre-transition One Year Post-transtion Source: Mathematica’s analysis of MFP QoL surveys and program participation data submitted to CMS through May 2016. Note: The analyses are based on surveys from 13,795 MFP participants. 19

Unmet Needs Declined Post Transition Autonomous in 6 Areas Can Get Needed Sleep 96.5 100.0 89.2 90.0 77.4 80.0 70.0 61.0 60.0 Percentage 52.5 52.4 50.0 40.0 30.0 22.5 20.0 13.5 10.0 0.0 Had Depressive Symptoms Did Not Have Depressive Symptoms Had Depressive Symptoms Did Not Have Depressive Symptoms Pre-Transition Post-Transition Pre-Transition Post-Transition Source: Mathematica’s analysis of MFP QoL surveys and program participation data submitted to CMS through May 2016. Note: The analyses are based on surveys from 6,688 MFP participants. Depressive symptoms are defined by affirmative responses to either of two questions: During the past week have you felt sad or blue? And During the past week have you felt irritable?. The autonomy measure is the percentage who answered “Yes” to all the following: (1) Can you go to bed when you want?, (2) Can you be by yourself when you want to?, (3) When you are at home, can you eat when you want to?, (4) Can you choose the foods that you eat?, (5) Can you talk on the telephone without someone listening in?, and (6) Can you watch TV when you want to?. The quality of sleep question was Can you get the sleep you need without noises or other disturbances where you live? 20

Next Steps? • Dem emonstr trati tions a are te e temporary • Either end or adopted permanently • Commu mmunity-based b ben eneficiaries a are l les ess costl tly a and h have a a high gher q quality ty o of l f life t e than those r e residing i g in facilities es • Divert beneficiaries from facility-based care • Focus on the transition when a facility admission occurs 21