Virginia’s Money Follows the Person

Jason Rachel, Money Follows the Person Project Director, DMAS

Governor’s Housing ConferenceNovember 19, 2009

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• Four-year Medicaid Demonstration Project to assist seniors and people with disabilities who currently live in institutions to move to the community if they choose to– Person-centered: Over 1,000 individuals in Virginia to move to

the community, each with an individual plan, supports they need, and someone to work with them before and after they move

– Community-based: Partnerships among human services and housing agencies (local government and private) are key

– State-planned and administered: Department of Medical Assistance Services (DMAS) (Virginia’s Medicaid agency) working with many other agencies, including state housing agencies

– Federally-sponsored: Centers for Medicare and Medicaid Services (CMS) (federal Medicaid agency)

Overview: Money Follows the Person Demonstration Project

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Community Supports for Individuals Who Transition

• Each individual will enroll in a Medicaid home and community-based “waiver” or a Medicaid program called “PACE”

• All Medicaid waivers and PACE pay for a variety of services available to people enrolled, based on their individual needs for each service

• Non-Medicaid services will also be available

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Housing for IndividualsWho Transition

• Each individual must move to a “qualified residence” in the community– Home owned or leased by the individual/family member– Apartment leased by the individual/family member– Setting in which no more than four unrelated individuals

reside

• Group homes (4 or fewer beds)

• Sponsored residential settings

• 4-bed Assisted Living Facilities

• Adult Foster Care

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New Medicaid Services Under Money Follows the Person

• Transition Services – Up-front household expenses when setting up a

household– Being added to five waivers– $5,000 lifetime maximum per person

• Transition Coordination

– 2 months before and 12 months after the individual moves

– Added to Elderly or Disabled with Consumer Direction Waiver

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Demonstration Services UnderMoney Follows the Person

• Environmental Modifications

– Assistance with making modifications to homes and primary vehicles to make them accessible

– Added to the Elderly or Disabled with Consumer-Direction and AIDS/HIV Waivers

• Assistive Technology– Devices that enhance one’s ability to function and communicate, such

as specialized toilets, braces, chairs, and computer hardware and software

– Added to the Elderly or Disabled with Consumer-Direction and AIDS/HIV Waivers

• 24-Hour Emergency Back-up Through 2-1-1 VIRGINIA for the first 12 months following transition to the community

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Non-Medicaid Services UnderMoney Follows the Person

• Supplemental home modification funding if amount needed exceeds Medicaid $5,000 maximum

• “Bridge rent” for up to 90 days after signing a lease if needed for home modifications to be completed before the individual moves

• Funding for each provided by the Virginia Department of Housing and Community Development

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Waiver Services That Help People Find Community Housing

• Depending on the waiver, one of the following providers is available to assist individuals moving to the community from institutions:

– Case Managers (MR, DD and AIDs Waivers)

– Transition Coordinators (EDCD Waiver)

– Health Care Coordinators (TECH Waiver)

• These are the people who will be contacting housing agencies when rental assistance is needed

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More Information on MFP

• Operational Protocol (Project Manual) contains extensive section and Appendices on housing:– Transition services, environmental and supplemental

home modifications, and bridge rent– Qualified residences

• Owning your own home• Renting a home or apartment (including HUD subsidies)• Living in adult foster care, assisted living facilities, sponsored

residential programs, and group homes

– Transportation information also included

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The Housing Challenges

• Lack of accessible housing stock

• Housing and human services plan in different systems

• Inability to afford housing

– People living in institutions often have no, or extremely low, income. • Sole income of many will be SSI, currently $638 per month.

• Some gave up homes to receive services in institutions because they could not access the services and supports they needed to stay in the community.

• While some may obtain employment, they will not have sufficient income at the time of transition to afford rent.

– Medicaid program cannot pay

– No state-funded programs exist

– Federal housing rental vouchers are scarce, and those available are not dedicated to individuals transitioning

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MFP Annual Housing and Transportation Action Plan

• STRATEGIES1. Increase the affordability and availability of

community housing for seniors and people with disabilities

2. Increase the availability of accessible transportation for seniors and individuals with disabilities

3. Recognize the importance of the link between housing and transportation

4. Focus on education, awareness, and partnership building among housing and human service agencies and the individuals they serve

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MFP Annual Housing and Transportation Action Plan

• Each strategy has:– A lead agency– A timeline

• Strategies recommended by Task Force have detailed work plans

• Office of Community Integration to track results

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Increase Affordability and Availability of Housing

• Develop a state-funded community living supplement• Increase availability of sponsored residential and adult

foster care providers through marketing and provider fairs

• Make the auxiliary grant portable for all populations• Produce new housing units through QAP LIHTC and

non-LIHTC initiatives, and low-interest loan programs– VHDA Housing Solutions Work Group

• Assess local housing capacity and assure that needs are included in local planning

• Direct federal housing trust fund monies, when they become available, to these populations

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Increase availability of accessible transportation

• Disseminate information about transportation providers that offer accessible vehicles, and about new services available under the New Freedom initiative

• Incentivize specialized transportation providers to coordinate their services beyond geographic boundaries

• Incentivize specialized transportation providers to provide door through door transportation

• Develop a transportation voucher system

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Recognize importance of the link between housing and

transportation

• Develop interactive housing and transportation website

• Use the existing Transportation and Housing Alliance Toolkit as a resource

• Create incentives to develop housing on public transportation routes

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Educate the housing community; awareness, and partnership

building– Offer assistance in follow up to HUD and Governor’s letters to PHAs– Provide technical assistance to local housing offices, planning

authorities and HUD offices on understanding the needs of persons transitioning, on www.accessva.org, and on laws that govern housing services, options and choice Encourage use of Virginia Easy Access.

– Distribute Rutgers Medicaid Services Primer at Governor’s Housing Conference

– Encourage PHAs to list accessible housing units on www.accessva.org

– Through speaking engagements, e-distribution list, HUD Lines and tele-tutorials, educate housing-related groups, including:

• VAHCDO, PHAS, Housing Counselors • COSCDA• Housing Commission• Local planners and contract administrators

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Educate disability/aging communities

– Orient individuals, advocates, local agencies to housing/transportation planning – Disseminate Annual Action Plan– Ensure input of disability/aging communities is considered in housing planning

activities; create a mechanism to track local changes in policy and relate ongoing needs/solutions to statewide and national housing funding agents and authorities

– Develop HOME, CDBG, and HCV contact lists; disseminate to organizations to encourage participation in needs statements and priorities for resource allocation

– Document changes in housing policy; work with the SILC to interface with multiple policy makers/funding agents to foster and sustain increased housing options

– Assure that service agencies and advocates have information about housing agencies and a description of the services they offer through:

• Virginia Easy Access • A housing resource bank on www.olmsteadva.com/mfp/ • Dissemination of information on HUD-Assisted Apartments• Training of Transition Coordinators • Developing a Housing Primer for services agencies and advocates

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For Further Information

Visit the Money Follows the Person Website http://www.olmsteadva.com/mfp/

E-mail MFP@dmas.virginia.gov