Mathematica Policy Research Evaluates MFP to Assess State Long-Term Care Systems

Federal and state Medicaid reimbursement policies, rather than individual needs, often dictate decisions related to providing long-term care services. The Money Follows the Person (MFP) demonstration, a federal initiative launched in 2005 and extended in 2010 as part of the Patient Protection and Affordable Care Act, provides funds to help states transition elderly people and people with disabilities from long-term care institutions to receive care in the community in the setting of their choice.

Mathematica Policy Research is evaluating MFP to assess how state long-term care systems will change to support the transition of people from institutions to the community, whether states can successfully transition people with significant needs for care, and to what extent MFP helps rebalance state long-term care spending.

The study’s fourth report provides an early assessment of the balance of long-term care systems in states before MFP is implemented. By looking at the status of long-term care systems state-by-state, the assessment helps to develop a baseline to measure the program’s impacts.

The main findings of the report include:

• In 2005, of the 2.79 million Medicaid beneficiaries who used long-term care services in MFP grantee states, 60% received home and community-based care services (HCBS), yet HCBS accounted for only 38% of spending for total long-term care services.

• There was large variation across states in the relative size of state HCBS programs: expenditures ranged from 13 to 59% of total long-term care spending, while the proportion of HCBS users ranged from 24 to 83%.

• Comparing states on a series of measures of long-term care systems revealed differences in the proportion of long-term care users receiving HCBS, the availability of state plan HCBS, the populations using HCBS, and the receipt of HCBS among new and established users of long-term care.

“This program aims to transition long-term care users out of institutions and into HCBS settings, so it’s important to establish a baseline of currently existing services,” said Carol V. Irvin in a press release. Irvin is a senior researcher at Mathematica and co-author of the report. “We found there were some key differences from state to state in the mix of institutional care and HCBS. Since these long-term care systems started at different points, our study suggests the effects of the MFP program will vary across states, which could have important implications as states look to balance their long-term care systems.”

The report, titled “The Starting Point: The Balance of State Long-Term Care Systems Before the Implementation of the Money Follows the Person Demonstration” is available for download.