Money Follows the Person
Minnesota among leaders in funding
the shift to community living
by Loren Colman
Disability advocates across
the nation are celebrating the recent passage of the federal Money
Follows the Person legislation. “Money
Follows Person” (MFP) grants appropriated in the federal Deficit Reduction
Act of 2005 present an excellent opportunity for other states to follow Minnesota’s
leadership in rebalancing services for people with disabilities and the elderly
from institutions to home and community-based settings. MFP is an approach that
“With
a 40/60 ratio, Minnesota ranks fifth among all states in
its percentage of public expenditures for the elderly and
people with disabilities in institutional versus community-based
services.”
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has proven to meet people’s
preferences and produce better individual outcomes while stretching
public dollars for long-term care.
Minnesota’s progress
in shifting the balance of supports for people with disabilities
and the elderly away from institutions toward home and community-based
settings is evidenced by several benchmarks.
• With a 40/60 ratio, Minnesota ranks fifth among all states in
its percentage of public expenditures for the elderly and people with
disabilities in institutional versus community-based services.
• The daily population of people under age 65 in nursing homes
has decreased from more than 3,300 in 2001 to 2,250 in 2006.
• Lengths of stay in nursing facilities have decreased dramatically
as more than 55 percent of people admitted to nursing homes currently
are discharged in six months or fewer, compared to less than 29 percent
in 2001.
For Minnesota, pursuing MFP funding would mean risking dilution
of our current efforts because of the effort and expense necessary
to secure, coordinate, implement and sustain new programs under the
MFP grant. Instead the Department of Human Services (DHS) has elected
to continue numerous MFP-like efforts to support people who want
to live, work and maintain maximum independence in the community.
“[Minnesota
is] among the first states to implement federally and state-funded
home and community-based waiver services … so
that older Minnesotans and people with disabilities can receive
services at home instead of in hospitals, nursing homes
and other institutions.”
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Key Minnesota initiatives include:
• Being among the first states to implement federally and state-funded
home and community-based waiver services as well as the Alternative
Care program for the elderly so that older Minnesotans and people with
disabilities can receive services at home instead of in hospitals,
nursing homes and other institutions. More recently, DHS has added
the Community Directed Community Supports option to all of the waivers,
thereby allowing individuals to hire family, friends and neighbors
to help with their care.
• Offering additional senior nutrition, health promotion, transportation,
chore and other targeted services to help seniors remain in their homes.
• Providing statewide information and assistance services for
the elderly and people with disabilities to direct them to products
and services they need.
• Implementing Medical Assistance for Employed Persons with Disabilities
in 1999 to allow people with disabilities to maintain MA coverage while
working, earning income and accruing assets.
• Forging new partnerships, improving coordination of services
and communication, enhancing public policy and strengthening transition
services and work experiences for youth and young adults with disabilities
in order to increase the number of people with disabilities in competitive
employment and meet Minnesota’s workforce needs. Pathways to
Employment, a four-year partnership begun in 2005 with support from
a federal Medicaid infrastructure grant, is conducted in partnership
between DHS, the Minnesota Department of Employment and Economic Development
and the Minnesota State Council on Disability.
• Launching a federally-funded pilot project, called the Demonstration
to Maintain Independence and Employment (DMIE), which will run from
2006 through 2008. The DMIE provides working people with serious mental
illness health care coverage and additional supports to enable them
to remain employed and independent.
• Since 2001, DHS and other state agencies have made an extra
push, through the Options Initiative and Options Too, to increase access
to community supports for people under 65 living in or at risk of being
placed in nursing homes. This drive is being supported with mandatory
face-to-face consultations before people under age 65 are admitted
to nursing facilities; funding and care coordination to help people
relocate from nursing homes if they wish; and more flexibility, choice
and control for individuals so their service needs at home can be better
met.
While other states begin to take steps to reshape services for people
with disabilities and the elderly, Minnesota is committed to sustaining
and furthering its considerable progress in offering quality, cost-effective
services where the vast majority of these populations want them. ![]()
Loren Colman is assistant commissioner for Continuing Care at Minnesota
Department of Human Services.
