You asked if legislation in Missouri, Texas, and Wisconsin requires Medicaid money to "follow the person" when a disabled or elderly individual transitions from a nursing home or other institution to the community (in other words, the same amount of Medicaid money that the state pays to the institution can be available to pay for the services the person needs to live in the community).

SUMMARY

Missouri passed the language you refer to in its 2000 and 2001 budget acts. Texas added it as riders in its budget in 2001. Below we describe the relevant parts of the legislation and provide links to the laws.

Wisconsin does not currently have such specific language in its law, but has a number of programs that encourage home and community-based care as an alternative to nursing homes and institutions.

BACKGROUND

Money follows the person legislation is one way Missouri and Texas have responded to the 1999 U. S. Supreme Court decision in Olmstead v. L. C. (119 S. Ct. 2176 (1999)). In that case, the Court decided that states cannot discriminate against people with disabilities by offering them long-term care services only in institutions when they could be served in the community, given state resources and other citizens' long-term care needs. OLR Report 2002-R-0559, entitled "Olmstead in Connecticut and Other States," provides more details on the court decision.

States' Medicaid programs generally have lower income eligibility limits for care at home or in the community than for care in a nursing home. Many states offer these home and community-based services under federal Medicaid waivers only if they would cost no more than care in a nursing home or limit the expenses to a certain lower percentage of nursing home care costs. In Connecticut, for instance, clients in the Connecticut Home Care Program for Elders (CHCPE) can receive services at home under the federal Medicaid waiver if they meet certain income and asset limits and their costs are no more than 100% of nursing home costs. People can also qualify for CHCPE's state-funded portion if they would otherwise be in a nursing home, their income would not be enough to pay for the nursing home, and they meet certain asset limits. For the state-funded portion, care costs are capped at 25% or 50% of nursing home costs, depending on the client's care needs. In 2000, the Connecticut legislature removed the specific income limit for the program's Medicaid and state-funded portions, but the change only took effect on the state-funded side because the federal government has not approved it for the Medicaid side. (The state also has a small state-funded pilot program for people who are denied Medicaid-funded home care because their incomes are slightly above the Medicaid limits, which will continue until the state obtains federal approval. )

Many states also cap the number of people who can be served under the Medicaid waivers as a way of limiting overall costs, often resulting in large waiting lists and difficulties in access to home and community-based services. Connecticut, on the other hand, now has 15,210 CHCPE slots for the current fiscal year and raises the number of slots as needed from year to year to avoid waiting lists. But waiting lists still exist in certain other types of Medicaid waivers in Connecticut because those programs have fewer slots. The Missouri and Texas legislation, by making the money follow the person out of the institution, encourages increases in the number of home- and community based slots and attempts to address the waiting list issue.

MISSOURI

The Missouri legislature enacted the money follows the person legislation as a part of its 2000 and 2001 appropriations acts for FYs 2000-01 and 2001-02, respectively.

In 2000, HB 1111, Section 11. 445, specified that individuals eligible for or receiving nursing home care must be given the opportunity to have those Medicaid dollars follow them to the community and to choose the personal care option in the community that best meets their needs. It also specifically requires that people eligible for the Medicaid Personal Care Option must be allowed to choose, from among all the options, the one that best meets their needs and must also be allowed to have their Medicaid funds follow them to whichever option they choose. The text is enclosed and can be found at:

http: //www. house. state. mo. us/bills00/biltxt00/truly00/HB1111T. HTM

In 2001, HB 11, Section 11. 440, restated the above principles using virtually the same language, but with the caveat that this language does not create any entitlements not established by statute. The text is enclosed and can be found at: http: //www. house. state. mo. us/bills01/biltxt01/truly01/HB0011T. HTM

Additional information on Missouri's Olmstead progress is available at:

http: //www. dolir. state. mo. us/gcd/Olmstead/OlmsteadWebpage121401. htm

TEXAS

The Texas legislature in 2001 added two riders to the Texas Department of Human Services budget for the 2002-03 biennium with variations of the money follows the person language to move Medicaid and other funds from nursing homes to home and community services.

Rider 37 of the 2001 Appropriations Act (SB 1) expresses the intent of the legislature that, as clients relocate from nursing facilities to community care services, funds will be transferred from nursing facilities to community care services to cover the cost of the shift in services.

Rider 7b generally limits the daily cost per patient of "alternate care" such as home and community-based care to no more than the average Medicaid nursing facility rate or the patient's nursing facility rate, whichever is greater, except for cases that the Human Services Board or commissioner individually exempts. But it also prohibits the department from disallowing or jeopardizing community services for individuals currently receiving services under Medicaid waivers if they need those services to live in the most integrated setting and if the exemption complies with federal cost-effectiveness requirements. In effect, someone

who costs more to live in the community than in a nursing home can receive those community services as long as the state's "aggregate" cost is not higher than the federal government allows.

The relevant parts of SB 1 are Article II Health and Human Services, Riders 7 (p. II-70) and 37 (p. II-79) to the Department of Human Services appropriations. They are enclosed and can be found at: http: //www. lbb. state. tx. us/Bill_77/4_Conference/Bill-77_Conference_0501. pdf

HN: ro