CDCAN REPORT #054-2011: Federal government releases proposed regulations on major new Medicaid "Community First Choice Option" program

• Federal Government Releases Proposed Regulations On New Medicaid “Community First Option” Program
• New Program Under Federal “Affordable Care Act” Seen In California As Way To Avoid Major Cut To IHSS Program By Tapping Into $4.3 Billion In New Federal Dollars To Help & Establish Community-Based Alternatives to Institutional Long Term Care – Could Help Other CA Health Programs

SACRAMENTO, CALIF  (CDCAN) [Updated 02/22/2011 – 04:04 PM  (Pacific Time)] –   United States Department of Health and Human Services Secretary Kathleen Sebelius [photo left] said today that states will see significant new federal funding in their efforts to help move Medicaid recipients out of institutions and into their own homes or other community settings, with the release of proposed regulations of a the new “Community First Choice Option” program and the announcement of 13 states who will receive funding under the “Money Follows the Person” program that was extended for another 5 years.  [CDCAN Note: a link to the proposed federal regulation, that also contains more details of the new program is listed below]

“Our country recognized in the Americans with Disabilities Act that everyone who can live at home or community-based setting should be allowed to do so,” Secretary Sebelius said. “The Affordable Care Act provides States critical new dollars toward achieving that goal.”

Today, Secretary Sebelius announced thirteen States would together receive more than $45 million in MFP grants to start that program in their States, with a total of $621 million committed through 2016. In addition, HHS has proposed rules to allow all States to access a potential of $3.7 billion in increased federal funding to provide long-term services and supports through the Community First Choice Option program.

The new program and the extension of the “Money Follows the Person” program were part of the federal “Patient Protection and Affordable Care Act” that was signed into law by President Obama on on March 23, 2010. The “Patient Protection and Affordable Care Act” and the Health Care and Education Reconciliation Act of 2010 (signed into law on March 30, 2010 by President Obama) made up the health care reform of 2010.

“Community First Choice Option” Critical To Helping Close CA Deficit

• The federal “Affordable Care Act” provides additional funding for those two programs and the goal of the “Community First Choice Option” program is to give states additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.
• This new program is seen as crucial in providing new federal matching funds for many states – including California, where there are proposals pushed by advocates to use the new funding to help off-set costs to the In-Home Supportive Services (IHSS) program and avoid the need for implementing the more drastic cuts.  It could possibly be a solution to help off-set outright spending cuts to other critical programs, including developmental services [CDCAN is issuing Action Alert urging support for this option for IHSS and also for possibly off-setting regional center funded community-based services and also for people to comment on the proposed federal regulations]
• “There is more evidence than ever that people who need long-term care prefer to live in their own homes and communities whenever possible,” said Dr. Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS), the federal agency under the US Department of Health and Human Services which will implement the demonstration program, “To restrict these individuals to institutions where even the simplest decisions of the day such as when to get up, what to eat and when to sleep are made by someone else must no longer be the norm. This new Federal funding will make a difference in people’s lives.

New Community First Choice Option Available to States

• Federal officials said that many of the same goals under the “Money Follows the Person”  demonstration projects are also shared by the “Community First Choice (CFC) Option”, created by the federal “Affordable Care Act”.
• The goal of this new option is to give states additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.
• Starting October 2011, this new option will allow states to receive a 6% increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.
• Over the next three years—through 2014—States could see a total of $3.7 billion in new funds to provide these services. States currently receive Federal Medicaid matching funds for these activities at the State’s normal matching rate.
• Services and supports that can be provided under “Community First Choice”  include, but are not limited to:  attendant services and supports that help individuals with activities of daily living such as bathing and eating, (similar to what In-Home Supportive Services provides in California) and health-related tasks through hands-on assistance or supervision (similar to IHSS and also to supported or independent living services funded through regional centers).
• States may also cover costs related to moving individuals from an institution to the community, such as security and utility deposits, first month’s rent, and purchasing basic household supplies.
• To qualify for the increased Federal funds, states must develop “person-centered plans” that allow the individual to determine how services are provided to achieve or maintain independence.
• States must also establish implementation councils with a majority membership consisting of persons with disabilities, elderly individuals and their representatives to advise in the design and implementation of the new “Community First Choice” option.
• IMPORTANT: The proposed regulations that will govern how the new “Community First Choice” program will be implemented, was posted today (February 22), describes the details of this program and solicits public comment.
• The proposed rule can be found at: http://www.ofr.gov/OFRUpload/OFRData/2011-03946_PI.pdf.

Thirteen States Receive Money Follows the Person Program Grants

• The federal “Money Follows the Person” (MFP) demonstration program, which was set to expire in fiscal year 2011, is extended through the federal “Affordable Care Act: for an additional five years.
• The 13 additional states receiving awards today  join the 29 States and the District of Columbia already operating MFP programs.
• The 13 states receiving awards today, as announced by Secretary Seblieus are: Colorado, Florida, Idaho, Maine, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, Rhode Island, Tennessee, Vermont and West Virginia
• Together, these 13 states will receive more than $45 million in the first year of the program, and more than $621 million through 2016.
• The “Money Follows the Person” program provides individuals living in a nursing home or other institution new opportunities to live in the community with the services and supports they need.
• Groups benefiting from these home-and-community based programs include the elderly, persons with intellectual, developmental and/or physical disabilities, mental illness or those diagnosed with several of these conditions.
• To date, according to the federal government, these programs have helped 12,000 individuals move out of institutions and back into their communities.
• Today’s grants to 13 additional states,  are expected to help an additional 13,000 people.
• “The Money Follows the Person program is hugely important to improving the lives of Medicaid beneficiaries,” said Donald Berwick, M.D., administrator of the Centers for Medicare & Medicaid Services (CMS), the federal agency under the US Department of Health and Human Services which will implement the demonstration program. “This helps bring everyone, even those who in the past may have had no choice but to live in an institution, into the community where they can become full participants in the activities most of us take for granted.”