You asked for information on the Texas “Money Follows the Person” program.

SUMMARY

Under Texas' Money Follows the Person program, people can move from nursing homes to the community without having to spend time on a waiting list for community-based services like people still living in the community who need these services (the waiting lists are considerable in Texas). It also permits public money, up to the amount that was spent on them in the nursing home, to “follow” them to the community (although in reality the cost of community care is usually considerably less than in the nursing home). People need not have been in a nursing home for a certain minimum number of days to qualify.

About 11,000 Texans have chosen to make this move since the program started in 2001. The people leaving nursing homes to receive home- and community-based services do not reduce the number of slots otherwise available in those programs, most of which are Medicaid waivers.

Texas overcame its administrative difficulties in transferring funds between functions by adding riders to appropriations bills that required the nursing home account periodically to money from the nursing home account to the home- and community-based services account to pay for this group's home and community-based services. 2005 legislation codified the requirement to transfer the funds between programs.

Connecticut's Nursing Facility Transition Program, which began with a federal grant and is now state-funded, is a pilot program aimed at some of the same goals as Texas, although it does not have authority to transfer funds between functions. The program has helped about 130 people move from nursing homes to the community since 2001. In addition, the pending Connecticut Department of Social Services application for one of the new federal Money Follows the Person Grants would, if approved, provide extra federal Medicaid funding to aid these transitions.

BACKGROUND

The Money Follows the Person program is one of several ways Texas has 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, if state resources and other citizens' long-term care needs permit it. OLR Report 2002-R-0559, entitled “Olmstead in Connecticut and Other States,” provides more details on the decision. As a result of the decision, many states, including Connecticut, have begun various efforts to reduce the number of people in institutions and increase the number in home- and community-based programs, often as part of an overall effort to “rebalance the long-term care system. ”

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, including Connecticut, offer these home- and community-based services under federal Medicaid waivers or with state funds only if they would cost no more than nursing home care or limit the expenses to a certain lower percentage of nursing home care costs. 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, though, now has over 15,000 slots in the Medicaid and state-only funded portions of its Connecticut Home Care Program for Elders and annually raises the number of slots as needed 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 Texas legislation, by permitting the money to follow the person out of the institution, bypasses the waiting list issue.

TEXAS

In Texas, the process of moving more people into home- and community-based services began in 1999 with an executive order from then-Governor Bush requiring the Texas Health and Human Services Commission to review and analyze all services available to people with disabilities, with a focus on improving the flow of information to consumers and removing barriers that impede community placement (GWB 99-2, 9/28/1999). A 2002 executive order by Governor Perry required the commission to review and amend state policies that impede moving children and adults from institutions under certain circumstances (RP 02-13, 4/18/2002).

Rider 37 of the 2001 Appropriations Act (SB 1), called the “promoting independence initiative” expresses the legislature's intent that funds will be transferred from nursing homes to community care services to cover the cost of clients relocating out of the homes to the community.

In 2003, the legislature renamed Rider 37 as Rider 28 and added a new Rider 37. The new Rider 37 amended the General Appropriations Act to express the legislature's intent that the Department of Human Services should not expand the base number of appropriated community care waiver slots through Rider 28 transfers. It stated that clients using Rider 28 remain funded separately through transfers from the nursing facility strategy (apparently what Texas calls an account in its budget), and those slots do not count against the total appropriated community care slots. When such a client leaves a waiver program, any remaining funding for the biennium remains in the nursing facility account (Appropriations to the Texas Department of Human Services, p. II-77, Ch. 1330, Acts of the 78^th Legislature, Regular Session, 2003).

Texas' new Department of Aging and Disability Services, created in 2004 as one of four departments under the umbrella Health and Human Services Commission, is now responsible for nursing homes and all home- and community-based Medicaid waivers for seniors and people with disabilities, including children (other than people with mental illness). It also oversees the Money Follows the Person program.

The money follows the person policy was recently reaffirmed in 2005 (House Bill 1867 codified at Sec. 531. 082 to Subchapter B, Chapter 531, Texas Government Code). This law codified the previous riders' requirement for the Health and Human Services Commission to quantify the appropriation for the rest of the fiscal biennium that it would have spent on nursing home care for a person moving to the community and to transfer up to that amount to a community program to cover the cost of care the person needed after leaving the nursing home. The text is enclosed and available at http: //www. legis. state. tx. us/tlodocs/79R/billtext/html/HB01867F. htm

A detailed description of Texas' efforts to rebalance the long-term care system in Texas, including the Money Follows the Person program, is available in a 2005 study by Rosalie and Robert Kane and others, “Rebalancing Long Term Care systems in Texas: Experience up to July 31, 2005” at http: //www. hcbs. org/files/94/4663/TX_Abbreviated_May_26,_2006_FINAL_06. 13. 06. pdf

RELATED RESOURCES

Texas Department on Aging and Disabilities website:

http: //www. dads. state. tx. us/index. cfm

Brief history of Texas' Promoting Independence Initiative:

http: //www. hhs. state. tx. us/news/circulars/C-002. shtml

2004 Texas Promoting Independence Plan

http: //www. hhsc. state. tx. us/PUBS/12XX04_tpip_rev. HTML

July 10, 2006 testimony of CMS Office of Public Affairs Director Dennis Smith before a U. S. House of Representatives committee on the future of long-term care and Medicaid, which comments favorably on Texas' program. http: //www. cms. hhs. gov/apps/media/press/testimony. asp?Counter=1893

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