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David M. Goldfarb
National Academy of Elder Law Attorneys
(703) 942-5711

Advocacy/Public Policy

The Program to Get People Out of Nursing Homes Expired: We Must Stop It From Going Extinct


By David M. Goldfarb, Esq.

Ensuring individuals with disabilities of all ages get services in the least restrictive setting is a top NAELA priority.

A middle-aged woman suffers from multiple sclerosis. She can’t walk freely and uses a power wheelchair to get around. Her husband is her only caregiver. When he dies, she ends up in a nursing home.

She’s in despair over having to live in a nursing home, but she has no close relatives to get her out. That’s when Money Follows the Person (MFP) steps in and changes her life.

MFP provides grants to states to cover transition services that Medicaid cannot normally cover under the law. This includes finding housing, purchasing furniture, and making accessibility modifications.

Using MFP, the state transitions her out to an apartment that they help make handicap accessible. Now she goes out to lunch, attends religious services, and generally lives a full life. 

MFP Funding Renewal Needed
Unfortunately, MFP expired in September 2016 (although many states still have funds available through the end of 2018). Thanks to the program, more than 75,000 individuals have been able to move out of an institution and back in the community.

For several years, aging and disability advocates, including NAELA, have teamed up to extend the program. The lobbying culminated in the Empower Care Act, introduced by Sens. Portman (R-OH) and Cantwell (D-WA) and Reps. Brett Guthrie (R-KY) and Debbie Dingell (D-MI). The bill extends the program until 2022 and reduces the length of stay in a nursing home requirement from 90 to 60 days.

The most recent push for renewal occurred in February when Congress struck a major budget deal that included many health provisions, such as a permanent repeal to the overturning of Ahlborn. Despite lobbying and Congressional support, an MFP reauthorization was not included.

One reason may be its size. Most members of Congress with whom advocates have met appear to support the MFP program, but there isn’t as much pressure at the district level to include MFP in legislation since relatively few people have benefited from the program in the past.

While the MFP program may be small now, it’s a critical piece of de-institutionalization. If we want to provide services in the least restrictive environment, then we need to provide the transition services needed to move many out of nursing homes. Without a program like MFP, this can’t happen because Medicaid does not normally cover these services by law.

Another hurdle that remains is its cost. No official Congressional Budget Office score exists, but it appears as if the agency may not offset the cost of the grants, $450 million per year, with the savings earned from transitioning individuals out of nursing homes and back to the community.

Beyond greatly improving quality of life, home and community-based services are cheaper on average per beneficiary. The Centers for Medicaid and Medicare Services found that states saved around 23 percent per beneficiary when placed in the community.

Given that some want to reduce the costs of the Medicaid programs, there is an interest in offsetting the costs within the system. Finding specific funding to cut within Medicaid may not be easy, as it’s often politically charged. That can take time and careful deliberation.

Meanwhile the clock is ticking. By the end of the year, the vast majority of states will likely lay off staff, seriously harming continuity with the program. That’s why NAELA has made this a top priority for 2018 and will continue to lobby to ensure the program survives.

About the Author
David Michael Goldfarb, Esq., is NAELA’s Senior Public Policy Manager.