Seema Verma hedshot
CMS Administrator Seema Verma
CMS Administrator Seema Verma

The Centers for Medicare & Medicaid Services will make up to $165 million in supplemental funding available to states operating Money Follows the Person demonstration programs to help state Medicaid programs boost efforts to move older adults and people with disabilities from nursing homes and other institutional settings to home- and community-based settings, the agency announced Wednesday.

Such of those home- and community-based settings could include assisted living communities that serve Medicaid beneficiaries via waivers.

CMS Administrator Seema Verma said the effort is being driven by “the tragic devastation wrought by the coronavirus on nursing home residents.”

“Home- and community-based care is not only frequently more cost effective, but is preferred by seniors and adults with disabilities seeking to maintain the dignity of independent living,” she said.

Each state is eligible to receive up to $5 million in supplemental funding for planning and capacity building activities to accelerate long-term care system transformation design and implementation, and to expand HCBS capacity. CMS said that states also could use the funding to support HCBS planning and capacity-building activities in direct response to the COVID-19 public health emergency, such as to plan and implement the use of telehealth for nursing facility transition activities that normally would be conducted in-person, or to redesign service delivery models to reduce the risk of COVID-19 infection among MFP program participants.

Brendan Flinn, director of Medicaid and home- and community-based services at LeadingAge, told McKnight’s Senior Living that the MFP demonstration has helped states improve their home- and community based services systems and increase options for older adults and people with disabilities. “LeadingAge supports funding for the program and hopes Congress extends MFP on a long-term basis,” he said. 

The impact on assisted living, however, “likely would be limited,” Flinn said. Approximately 10% of all MFP participants have moved to an assisted living community from a nursing home.

The MFP program started in 2007 and since then, state grantees have transitioned 101,540 Medicaid beneficiaries from institutional care to home-based and community services, according to CMS. Last year, however, only 4,173 Medicaid beneficiaries were transitioned under the MFP program, a 46% decrease from 2018, the agency said. 

“Depending on what steps states take with these dollars, there could be some transitions from nursing homes to assisted living units funded by this disbursement. However, the amount each state will receive is relatively small compared to overall Medicaid long-term services and supports costs and previous funding allocations for MFP,” Flinn said.

Mike Cheek, senior vice president of reimbursement policy for the American Health Care Association / National Center for Assisted Living told McKnight’s Senior Living that the organizations’ stance is that “individuals who require long-term services and supports should be able to access the setting of their choice as well as the most appropriate setting for their needs.”

“We support efforts to expand home- and community-based settings and integrate all settings to better serve individual needs, but not at the expense of nursing home care,” he said. “Each long-term care setting has an important role to play, each contributing to a continuum of care.”

The impact of COVID-19 on nursing facilities is not a failure of the facilities, he said, “but rather a systemic failure to prioritize and direct aid to these residents and caregivers when we knew they were especially vulnerable and lacking resources prior to and during the pandemic.”

AHCA/NCAL, Cheek said, wants policymakers “to pursue efforts that support every type of long-term setting, including helping providers reinvent care delivery, so they can provide the best care possible.

“Let’s focus on the needs and preferences of the individual, who deserves the utmost care at every step of the journey,” he said.

Read additional coverage from our sister site, McKnight’s Long-Term Care News.