Association for Public Policy Analysis & Management

Older adults and people with disabilities exiting long-term care facilities need diverse types of services and supports to live successfully in the community. Some of these people have lost their housing when they entered the facility and the majority have high health care needs due to a mental illness or chronic medical condition such as hypertension, depression, diabetes, and stroke. The Money Follows the Person (MFP) Demonstration supports state efforts to help Medicaid beneficiaries living in long-term care facilities transition back to the community. States may also use MFP grants funds to expand the availability of home- and community-based services to meet individual’s support needs during their first year of community living. With the support of MFP grants, 45 states have transitioned nearly 52,000 Medicaid beneficiaries from institutional settings to the community between 2008 through 2014, nearly 40 percent of whom are people younger than 65 with a physical disability. In this paper, we examine how six states are using grant funds to better serve populations with diverse needs and what factors have contributed to their strong performance. The six states were identified to be leaders, based on having scored higher relative to other state MFP grantees on key outcome measures, in supporting four populations in the community: older adults and those with physical disabilities who transition from nursing homes, people with intellectual disabilities, and people with mental illness. This paper illustrates how these states have translated lessons learned from program development to better serve people with complex medical and support needs in community settings.