Educational Objectives
1. Describe Virginia\u27s Money Follows the Person Demonstration project, including the new services available to individuals through Virginia\u27s Medicaid-funded home and community-based waiver program.
2. Explain how Virginia\u27s Money Follows the Person Demonstration project, being administered by the Virginia Department of Medical Assistance Services (DMAS), would assist an individual in transitioning from a long-term care facility to the community.
3. Illustrate how someone might experience the MFP processes from pre-transition through post-transition

Lawson, Karen

Rachel, Jason A.

English

VCU Scholars Compass

Masthead LogoVirginia Commonwealth UniversityVCU Scholars CompassCase Studies from Age in Action Virginia Center on Aging2009Virginia's Money Follows the PersonDemonstrationJason A. RachelVirginia Department of Medical Assistance ServicesKaren LawsonVirginia Department of Medical Assistance ServicesFollow this and additional works at: https://scholarscompass.vcu.edu/vcoa_casePart of the Geriatrics CommonsCopyright managed by Virginia Center on AgingThis Article is brought to you for free and open access by the Virginia Center on Aging at VCU Scholars Compass. It has been accepted for inclusion inCase Studies from Age in Action by an authorized administrator of VCU Scholars Compass. For more information, please contactlibcompass@vcu.edu.Recommended CitationRachel, J., & Lawson, K. (2009). Virginia's Money Follows the Person Demonstration. Age in Action, 24(1), 1-5.Virginia’s Money Follows the PersonDemonstrationby Jason A. Rachel, M.S.Karen Lawson, M.S.W.Educational Objectives1. Describe Virginia’s Money Fol-lows the Person Demonstration pro-ject, including the new servicesavailable to individuals throughVirginia’s Medicaid-funded homeand community-based waiver pro-gram.2. Explain how Virginia’s MoneyFollows the Person Demonstrationproject, being administered by theVirginia Department of MedicalAssistance Services (DMAS),would assist an individual in transi-tioning from a long-term care facili-ty to the community.3. Illustrate how someone mightexperience the MFP processes frompre-transition through post-transi-tion.BackgroundThe Money Follows the PersonDemonstration (MFP) is a nationalinitiative of the federal Centers forMedicare and Medicaid Services(CMS). The MFP Demonstration’svision is to create a system of long-term services and supports thatenables available funds to “followthe person” by supporting individu-als who choose to transition fromlong-term care institutions into thecommunity. Nationally, $1.4 billionwas allocated to the 31 states par-ticipating in the program, with anestimated 37,000 individuals pro-jected to transition to the communi-ty over the four-year demonstration.Virginia’s MFP Demonstrationwent “live” on July 1, 2008 andwill operate through September 20,2011.Activating MFP in VirginiaThe MFP Demonstration gives indi-viduals of all ages and all disabili-ties who currently live in institu-tions in Virginia options for com-munity living not previouslyoffered.  To accomplish this, Vir-ginia’s MFP Demonstration willmake permanent changes to Vir-ginia’s long-term support system,enabling individuals to use one offive Medicaid home and communi-ty based waivers or one of Vir-ginia’s Programs for All-InclusiveCare for the Elderly (PACE).  Thechanges also reflect Virginia’s com-mitment to rebalance further itslong term support system andencourage community-based sup-ports in lieu of institutional care.The MFP Demonstration has threemajor goals.  They are:  Goal 1. To give individuals wholive in nursing facilities, Intermedi-ate Care Facilities for Individualswith Intellectual Disabilities/MentalRetardation and Related Condi-tions, and long-stay hospitals moreinformed choices and options aboutwhere they might live and receiveservices.Goal 2. To assist individuals inmaking the transition from theseinstitutions, if they choose to live inthe community. Goal 3.  To promote quality carethrough services that are person-centered, appropriate, and based onindividual needs.  The MFP Demonstration Projectanticipates achieving these goals byInside This Issue:VCoA Editorial, 5VDA Editorial, 7VCoA Focus: Monica Hughes, 9Memory Up in Smoke, 10It’s More than a Pie Hole, 11Farsightedness, 12Caregiver Survey, 13Beard Center on Aging, 14ARDRAF Call for Proposals, 16Religion, Aging, & Spirituality, 17Calendar of Events, 18Guardianship Conference, 20Case Study2adding both new and existing waiv-er services to select Medicaid homeand community-based waivers.Specifically, the MFP Demonstra-tion created the following two newhome and community-based waiverservices:Transition Services: A one-time,life-time $5,000 benefit for thoseindividuals transitioning from aqualified institution to a qualifiedcommunity setting to assist withitems and services needed for a suc-cessful transition.  Examples oftransition services include rentaldeposits, utility deposits, and essen-tial household appliances and fur-nishings.Transition Coordination: A time-limited service similar to case man-agement that provides needed sup-port for the individual with activi-ties that are associated with transi-tioning, including the developmentand implementation of the transi-tion and service plan.In addition to the new waiver ser-vices, DMAS added certain existingwaiver services to select home andcommunity-based waivers.  Thefollowing chart illustrates theseadditions, as a result of the MFPDemonstration:  DMAS anticipates that 1,041 indi-viduals across Virginia will makethe transition from institutions intohome and community-based set-tings during the MFP Demonstra-tion’s four-year implementationperiod. Case StudyPre-Transition Period:  Makingthe DecisionEthel is a 64 year-old woman whoreceives Medicaid services and haslived in a large, state-run trainingcenter for 52 years.  The seventh ofnine children, she had lived withher family until her needs precipi-tated admission to this facility.  Shehas a profound intellectual disabili-ty and bilateral foot deformitieswhich keep her from walking inde-pendently, though she wears customshoes and inserts.  Ethel spends alot of time in her wheelchair, whichshe propels using her feet.  Withassistance, she can stand in order toget in and out of bed, the shower, orher favorite recliner.  Ethel does notspeak, but sometimes makes vocalsounds when she is especiallyhappy or unhappy.  She expressespreferences through her visual gaze,through vocalizations or by wheel-ing herself away from an area.Ethel eats a pureed diet.  She drinksfrom a cup and can feed herselfsmall amounts, although she prefersfor others to feed her.  She seems tolike upbeat country music, but oth-erwise shows little interest in her environment and seldom reacts toor reaches for objects around her.The facility has tried to promotegreater awareness of herself and herenvironment, for example, byencouraging Ethel to make eye con-tact with others for brief periodsand to look in a mirror.  Etheldepends on others for all aspects ofher care, and is generally coopera-tive with whatever needs to bedone.Interdisciplinary Teams at the train-ing center are responsible for iden-tifying individuals who may wish toparticipate in this Project.  Ethel’s Interdisciplinary Team suspectedthat she might be interested in liv-ing in the community, so it contact-ed her brother to discuss the possi-bilities, as well as potential risks tocommunity living.  When an indi-vidual in a Virginia state facility hasa legal guardian, or if an AuthorizedRepresentative has been appointed,that representative must agree withcommunity placement and giveconsent for transition planning tobegin.  Both of Ethel’s parents aredeceased but she had a brother liv-ing in the family’s hometown and asister in California.  Ethel’s brotherhad been appointed as her Autho-rized Representative.  When thefacility’s social worker providedinformation about services avail-able in the community and aboutEthel’s ability to participate in thisProject, he strongly embraced theprospect of community placementand gave all of the necessaryinformed consents for discharge3planning to begin.  This includedhis written permission for Ethel toparticipate in the MFP Demonstra-tion. The facility began coordinat-ing with the Community ServicesBoard serving Ethel’s home countyin order to obtain a slot on the MRWaiver list for Ethel.  Ethel met thecriteria for this waiver, for the crite-ria for residency in the training cen-ter (which is an intermediate facili-ty for individuals with intellectualdisabilities/mental retardation) arethe same as for the MR Waiver.Since Ethel was participating in theProject, she immediately receivedone of the 110 MR waiver slotsreserved for those who needservices under the Project’s MRWaiver.The Transition: Careful CoordinationEthel’s brother requested that com-munity services be located as closeto the family home as possible.  Atthe same time, he decided that hedid not want to take an active rolein setting up Ethel’s services butwished to be kept fully informed bythe Community Services Board andthe facility’s social work staff.  TheMental Retardation Director of theCommunity Services Board con-tacted several residential providersmeeting the geographic criteria,both group home and sponsoredresidential placements, and invitedthem to the facility to meet Etheland gather information from theteam on her living unit.  After con-sidering available providers, theirlocations, their proximity to activi-ties of interest to Ethel, and popula-tions served by each provider, Ethelselected Apple Valley group homewhose owner was eager to developservices for her in the community.The provider articulated a vision fora small three-bed group home locat-ed not far from the family home,which would be configured to meetEthel’s physical needs and whichwould offer a comfortable, safeenvironment with a gentle boost inthe activities and stimulation avail-able to her.  The facility’s socialworker, who had established aclose, trusting working relationshipwith the family over many years,endorsed this plan.  Ethel’s brothergave consent for transition planningto begin, and the provider startedthe process of identifying an appro-priate house and appropriate house-mates for Ethel.  Her case manageradministered the first Quality ofLife Survey to Ethel, and her broth-er assisted her in responding.Unfortunately, Ethel’s brotherpassed away soon after this, andthere was a short interruption intransition planning.  Ethel’s sister inCalifornia was initially hesitantabout Ethel’s ability to live in thecommunity.  Training center staffconnected Ethel’s sister with thefamily of an individual who hadmoved into a group home severalmonths ago.  Ethel’s sister spokeseveral times with the family, learn-ing how many supports are now inthe community to address individu-als and their safety needs. Afterlearning of these improvements,Ethel’s sister was equally in favorof the community placement; ittook a couple of weeks for the facil-ity to designate her as an Autho-rized Representative and obtain thenecessary informed consents, whichincluded consent to participate inthe Money Follows the Person Pro-ject.  As can be seen, in the MFPprogram, any conflict or difficultythat might arise during the stages ofthe transition is dealt with individu-ally on a case-by-case basis, involv-ing the person who is transitioning,or the Authorized Representative,and the Case Manager/TransitionCoordinator.  This is due to thedynamic and unique nature of eachtransition planning/implementationprocess. When planning resumed,staff members from the facility andthe group home coordinated a seriesof information-sharing and transi-tional activities:• The residential manager and assis-tant manager from Apple Valleyspent an entire evening shift andpart of the following day shift onthe living unit with Ethel and herstaff, observing and learning hercare routines.  The facility providedon-grounds accommodations for thecommunity group home (provider)staff;• Staff members from the facilityreviewed with provider staff the lat-ter’s responsibility to offer staffingin accordance with needs; • A team of facility staff memberswho knew Ethel well, includingstaff from social work, direct care,and physical therapy, visited theprospective group home site toassess the property and provide rec-ommendations for modifications tothe physical plant based on Ethel’sneeds.  Following this visit, thegroup home provider modified theproperty by installing a front porchramp and a curb cutout, wideninginterior doorways, and fitting grabbars and a transfer seat in the bath-room and corner guards on furni-ture.  Facility staff also recom-mended the correct height forEthel’s bed for the most effectivetransfers.• Ethel’s annual review fell withinthis period, and the provider’sadmissions coordinator attended herinterdisciplinary team meeting.Up-to-date reports from all disci-plines were provided, along withsubstantial anecdotal information.It was clear at the meeting that thefacility’s team members (a sizeablegroup) knew Ethel, cared about her,and were genuinely supportive ofher move to the community.• In late March, facility staff mem-bers brought Ethel to her new grouphome for a day visit that includedlunch. Ethel also met the other twoindividuals who were living in thehome; they all seemed to like eachother.  The visit was a success.  Thefacility later gave glowing feedbackon Ethel’s apparent comfort levelthroughout the day and on how wellprepared the group home staffmembers were.  The residentialprovider had purchased a loungechair very similar to Ethel’s favoritechair on the facility living unit, aswell as a full-length mirror similarto the one facility staff membershad been teaching her to use. • Facility nursing staff coordinatedwith Ethel’s new community physi-cian to share information and toschedule her first appointment.Nursing staff also coordinated thetransfer of medications and physi-cians’ orders to the group home.Life after Transitioning into theCommunityEthel moved into her new home inthe spring.  In case Ethel needed toreturn, the facility placed her on“convalescent leave” with her dis-charge date being not until a monthlater.  This precaution turned out tobe completely unnecessary.  Withinthe first month, Ethel was settled in,attending a Memorial Day picnicand some other events with undis-guised pleasure, and even startingto pick out her favorite staff.  Clear-ly, she was “home.”Although Ethel now lives in a dif-ferent county from where she grewup, her original Community Ser-vices Board continues to provideher case management.  This boardassigned a case manager for Ethelshortly before her discharge fromthe facility; the case manager sub-mitted the service authorizationrequest and other required paper-work to the Office of IntellectualDisabilities for approval, and nowvisits Ethel at least every 90 days,monitors service delivery, main-tains contact with her family, andfulfills the other functions requiredby waiver regulationsDuring Ethel’s first 60 days in hernew home, the group homeprovider conducted a comprehen-sive assessment of her skills andinterests.  Then, staff members metwith Ethel and her case manager todevelop a person-centered serviceplan for the coming year.  (Ethel’ssister was unable to attend, but wassent copies of all plan materialslater.)  Although staff had initiallyconsidered establishing trainingobjectives like those at the facility(making brief eye contact, lookingin a mirror) for the sake of consis-tency, they discovered that she wasnot nearly as detached from her sur-roundings as had been thought.Ethel was already making more andmore eye contact with others andwatching what people were doing.She laughed out loud during certainTV shows.  Staff noticed that sheenjoyed watching birds out thekitchen window from her seat at thebreakfast table.  Ethel was moreready for her new life than anyonehad suspected. Ethel will continue to receive theseservices even after her participationin the Money Follows the Projectends because the services she isreceiving are a part of the MRWaiver.  Staff members from theDepartment of Medical AssistanceServices will visit Ethel at the endof one and two years following hertransition to see how Ethel is doingand to complete the Quality of LifeSurvey as a part of evaluating thesuccess of the MFP Demonstration.Study Questions1. What are the new home and com-munity-based Medicaid waiver ser-vices created as a result of Vir-ginia’s Money Follows the PersonDemonstration project?2. What are the steps necessary fora successful transition under Vir-ginia’s Money Follows the PersonDemonstration project?3. Who should be involved in theprocess in order to ensure a positivetransition into the community?ReferencesFor more information about Vir-ginia’s Money Follows the PersonDemonstration project, includingeligibility requirements and a list ofTransition Coordination ProviderAgencies, visit:www.olmsteadva.com/mfp(Virginia’s MFP Website)http://www.cms.hhs.gov/DeficitRe-ductionAct/20_MFP.asp(Federal MFP Website)45About the AuthorsJason Rachel is theMoney Follows thePerson Project Direc-tor at the Departmentof Medical Assis-tance Services(DMAS). He is responsible for thedevelopment, implementation,monitoring, and evaluation of theMoney Follows the Person Demon-stration Project.  Mr. Rachel gradu-ated from Virginia CommonwealthUniversity in December 2000, earn-ing a Master of Science in Geron-tology degree with a track ofHealthcare Organization and Plan-ning.  He has held positions ofresponsibility in long-term care andin higher education. Currently, he ispursuing a doctorate in HealthRelated Sciences with a specializa-tion in Gerontology under the direc-tion of the VCU School of AlliedHealth Professions.  Karen Lawson isthe Policy andResearch Managerat DMAS, Divi-sion of Policy andResearch.  She is responsible formanaging and completing large-scale research projects, policy andprogram development, grant devel-opment and monitoring, and policyanalysis support for the Medicaidprogram.  Ms. Lawson graduatedfrom James Madison University in1993 with a Bachelor in SocialWork degree, and from VCU in1996 with a Master in Social Workand a Certificate in Aging Studies.Ms. Lawson has been employedwith DMAS since 1996,  specializ-ing in long-term care services pro-vided to Medicaid populations.

Virginia\u27s Money Follows the Person Demonstration

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Virginia\u27s Money Follows the Person Demonstration

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