Two weeks ago, CMS sent out "Money Follows the Person Rebalancing
Demonstration Request for Additional Information" letters to 21
states.
These are the 21 States that were not awarded "first round" MFP
grants of more than $800 million, but are eligible for a "second
round" grant.
These 21 states have only until February 20 to respond to the CMS
questions and concerns.
Whether your State will receive a MFP grant in the "second round"
($700 million remains) depends on how your State responds to CMS'
questions and concerns. Based on the CMS letters we have seen, CMS
appears serious about requiring "Rebalancing Benchmarks," i.e.,
how will your State decrease the ratio of institutional to
community expenditures?
What will your State, in order to receive the enhanced federal
match, do to demonstrate its seriousness on the home and community
based side of the scale?
CMS suggests one "measurable benchmark" which we think is critical
and will demonstrate if your State is really serious about
"rebalancing" its Medicaid long term care expenditures. Namely,
CMS suggests "A percentage increase in Home and Community Based
services versus institutional long-term care expenditures under
Medicaid for each year of the demonstration program." CMS is
right on the mark!
For the past several springs we have provided by State a
comparison of the Medicaid expenditures for institutional versus
community-based services.
Nationally in FY 2005, for persons who receive "A/D" services,
i.e., older Americans and disabled persons, nearly 73% of the
funds went to the institutions and 27% went to community-based
services.
A true rebalancing benchmark would reduce those ratios so that
each year, as one example, the percentages for institutional care
would be reduced by 5% and the community-based services
expenditures would be increased by 5%.
By the end of the five year grant, we would see a true
"rebalancing." The same principle applies for MR/DD services.
Congress understood that the primary purpose of MFP was to
"rebalance" Medicaid's expenditures from the institution to the
community.
Why would a State not want to rebalance and to establish such
benchmarks in return for an increase in federal money? How could
CMS ever approve an State's proposal that did not establish such benchmarks?
Disability Advocates:
- Do you know if your State was one of the 21 that received
a request for additional information?
- If it was, has your State Medicaid agency shown you the CMS letter?
- Are you meeting with your State to discuss these benchmarks
and the rebalancing?
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