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Report: Medicaid Program Struggles to Get Long-term Care Patients Back Home

Cheryl Clark, for HealthLeaders Media, November 20, 2009

Economic and bureaucratic barriers have thwarted an ambitious $1.7 billion Medicaid demonstration project, "Money Follows the Person," from getting elderly and disabled beneficiaries released from long-term care so they can return to live in their communities, according to a report from the non-profit research firm, Mathematica Policy Research.

Instead of transitioning 4,000 individuals back to their homes or community-based care programs in the first 15 months, as the program intended, only 1,482 individuals were given that opportunity, according to Mathematica. The program had intended to transition 34,000 individuals to home and community care by 2013.

The company was contracted by the Centers for Medicare and Medicaid Services to write the report.

Mathematica detailed several reasons why the program has stumbled in all but four of the 29 states and the District of Columbia that agreed to participate.

  • In half of the states, community level barriers, such as lack of affordable and accessible housing and rental vouchers, hindered the states' ability to transition as many people as originally planned.
  • Worsening state budgets because of the economic downturn strained state Medicaid management resources and staff, as well as the capacity of many home and community service organizations to take in more residents.
  • Many states lack affordable and accessible housing options.
  • One-third of the states report shortages of home- and community-based services, providers and direct care workers, making it difficult to ensure environments that are safe and provide adequate care.
  • In two-thirds of the participating states, programs began late because of delays in meeting planning and reporting requirements.
  • In some states, assisted-living facilities were excluded from the definition of a qualified community residence, although some participants may prefer that type of housing.
  • The six-month minimum institutional residency requirement was seen as too strict because many candidates had not been institutionalized that long. Those who had been institutionalized for that length of time frequently have complex medical or mental health conditions that make it difficult to provide care and support for them in the community.

Qualifying individuals are Medicaid beneficiaries who had been institutionalized at least six months in nursing homes, hospitals, intermediate care facilities for the mentally retarded or institutions for mental diseases.

Qualifying residences where they could move to include their homes, an apartment or a small-group home with no more than four unrelated individuals.


Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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