Following are important aspects of the CMS Announcement Re Funding for MFP awards:

1. The State Medicaid Agency "must be the lead applicant." CMS will award grants for two to five years. Therefore, Disability advocates should have a statewide coalition to develop your State's proposal with your MA agency.
   
   
2. Your State must indicate both "the targeted group(s) AND number of individuals it intends to transition." Therefore, your statewide coalition should agree regarding how many people and what groups should be transitioned out of institutions.
   
   
3. CMS will give preference to States that "include multiple target groups including older individuals, and if they propose to deliver self-directed services." Therefore, your statewide coalition should be composed of ILCs, AAAs, AARP, ARCs, HIV/AIDS, BI, AND MI advocates (yes, there really are institutions for person with MI who are "unnecessarily institutionalized.") This could be a new and surprisingly happy experience - a true Disability coalition working together; wouldn't that be a positive twist.
   
   
4. Extra points are awarded for "consumer emphasis." CMS stated that "to maximize scoring [for consumer involvement], the consumer and/or consumer-run organizations must participate in ways that GO BEYOND ADVICE GIVING. Maximum credit will go to proposals that show evidence of some form of CONSUMER DECISION MAKING." Therefore, Disability advocates should make sure that they are really part of the "consumer emphasis" and not just window dressing. We've all heard too many stories of State officials picking providers to represent consumers, stories of "consumers" who work for the State or for agencies that are beholden to a State agency, stories that States do not want vocal advocates to participate. WELL NO LONGER. Disability advocates should decide for themselves who will be the "consumer emphasis" and should inform your MA agency in writing. IF your MA agency does not include you, then you should tell CMS not to award extra points. CMS wants real Disability advocates to participate!
   
   
5. One of the MFP objectives is to "eliminate barriers or mechanisms, whether in:
   1. the State law [for example, Nurse Delegation barriers],
   2. the State MA plan [for example,
      1. about 15 States do NOT currently offer the MA Personal Care Option;
      2. many States discriminate/have barriers against persons with the most severe disabilities who require significant amount of services in the community (like persons who use ventilators),
      3. many States set unreasonably few hours for necessary community support services and force persons to be unnecessarily institutionalized instead of increasing the hours of service in the community,
      4. not requiring a meaningful and effective "single point of entry" before a person is institutionalized,
      5. not providing housing modification or rental assistance],
   3. the State budget [for example, expanding institutional beds and paying for unused beds, unequal distribution of funds between institutions and community programs]..." Therefore, Disability advocates should decide which barriers are the most important and make your MA agency address them.
      
      
6. States have the option to include "supplemental demonstration services" necessary to transition to the community. These are not long-term and are "not otherwise considered Medicaid services, but are essential to successful community living." Examples include assistive technology, DME, service animals, nutrition services and housing (which is discussed next).
   
   
7. CMS acknowledged that "States... have repeatedly identified housing as a tremendous barrier to participation." Extra points are awarded for States whose applications address eliminating housing as a barrier to returning to the community. CMS provides examples of what could be done regarding housing:
   1. MFP funds can be used "to promote availability of housing for populations with chronic conditions." These include costs for new construction and conversion of properties. Therefore, Disability advocates should assist your MA agency in combining one-time MA housing funds with other funds that the State could use, for example, HOME funds, CDBG funds, Low-Income Housing Tax Credits. Most MA agencies probably have never historically worked with the State housing agencies and vice a versa.
   2. MFP funds can be used "to promote affordability" of housing, including rental assistance, temporary bridge programs, and homeownership. CMS recognized that there were long waiting lists for HUD's housing vouches so that MFP funds can be used to provide "immediate assistance in securing housing." Therefore, Disability advocates should help your MA agency develop a transition rental assistance subsidy program (again HOME funds, currently only 3% of HOME funds are used for Tenant-Based Rental Assistance, could be used to develop a package of rental subsidies, as well as working with local Housing Authorities to use "turnover" housing vouchers that are targeted for persons with disabilities). HOME funds could also be used for homeownership.
   3. MFP funds can be used "to promote accessibility" of housing, including home modifications and universal design. Therefore, Disability advocates should ensure that your State's multiple programs (for example, HOME, LIHTC, CDBG, US Dept of Agriculture) modify their entire programs to achieve accessibility.
   4. MFP funds can be used to furnish an apartment, pay for security deposits, utility set-up fees, and one-time cleaning prior to occupancy.
      
      

The MFP funding process presents a unique opportunity for Disability advocates. Please take advantage. If you have further questions, email me at stevegoldada@cs.com or tel 215-627-7100.

Back issues of other Information Bulletins are available online at http://www.stevegoldada.com with a searchable Archive at this site divided into different subjects. To contact Steve Gold directly, write to stevegoldada@cs.com.