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Implications of the Expiration of Medicaid Long-Term Care Spousal Impoverishment Rules for Community Integration

To financially qualify for Medicaid long-term services and supports (LTSS), an individual must have a low income and limited assets. In response to concerns that these rules could leave a spouse without adequate means of support when a married individual needs LTSS, Congress created the spousal impoverishment rules in 1988. Originally, these rules required states to protect a portion of a married couple’s income and assets to provide for the “community spouse’s” living expenses when determining nursing home financial eligibility, but gave states the option to apply the rules to home and community-based services (HCBS) waivers.
Section 2404 of the Affordable Care Act (ACA) changed the spousal impoverishment rules to treat Medicaid HCBS and institutional care equally from January 2014 through December 2018. Congress subsequently extended Section 2404 through December 2019. This issue brief answers key questions about the spousal impoverishment rules, presents 50-state data from a 2018 Kaiser Family Foundation survey about state policies and future plans in this area, and considers the implications if Congress does not further extend Section 2404.

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Medicaid’s Money Follows the Person Program: State Progress and Uncertainty Pending Federal Funding Reauthorization

Medicaid’s Money Follows the Person (MFP) demonstration has helped seniors and people with disabilities move from institutions to the community by providing enhanced federal matching funds to states since 2007. The program operates in 44 states and has served over 90,000 people as of June 2018. The program is credited with helping many states establish formal institution to community transition programs that did not previously exist by enabling them to develop the necessary service and provider infrastructure. With a short-term funding extension set to expire on December 31, 2019, MFP’s future remains uncertain without a longer-term reauthorization by Congress.

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The Henry J. Kaiser Family Foundation

Case Study: Michigan’s Money Follows the Person Demonstration

This case study looks at Michigan’s Money Follows the Person (MFP) demonstration program, which has enabled the state to accelerate existing transition activities and increase access to home- and community-based services (HCBS) by providing enhanced federal funds for each MFP participant’s 365-day enrollment period. Through MFP, Michigan is able to…

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The Henry J. Kaiser Family Foundation

Money Follows the Person Medicaid Demonstration Program: Helping People Move Back Home

This paper contains short profiles four Medicaid beneficiaries who have been helped by Money Follows the Person demonstration programs in Michigan and Washington state.

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The Henry J. Kaiser Family Foundation

Money Follows the Person: A 2012 Survey of Transitions, Services and Costs

The Affordable Care Act extended the Money Follows the Person (MFP) demonstration grant program through 2016, giving states further options to transition Medicaid beneficiaries living in institutions back to the community. Enacted into law in 2006 as part of the Deficit Reduction Act (DRA), the MFP demonstration provides states with…

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The Henry J. Kaiser Family Foundation

Case Study: Georgia’s Money Follows the Person Demonstration

This brief reports on a case study of Georgia’s Money Follows the Person (MFP) demonstration program, describing key features of the program and highlighting recent program experiences. The Georgia Department of Community Health (DCH) implemented the program in September 2008. In 2005, before the demonstration began, Georgia’s long-term care expenditures…

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The Henry J. Kaiser Family Foundation

Medicaid’s Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings

The nation’s primary payer for long-term services and supports, Medicaid finances 43 percent of all spending on long-term care services and covers a range of services and supports, including those needed by people to live independently in the community, as well as services provided in institutions. This report provides an…

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The Henry J. Kaiser Family Foundation

Long-term Services and Supports: A Rebalancing Act

The ongoing debate over the federal budget and deficit reduction presents a balancing act for policymakers, as many compelling interests compete for scarce dollars. But for 10 million older adults and people with disabilities who need long-term services and supports, there is a “rebalancing act” in progress. The aim is…

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The Henry J. Kaiser Family Foundation

Money Follows the Person: A 2013 State Survey of Transitions, Services, and Costs

The Money Follows the Person (MFP) demonstration provides enhanced federal matching funds, allowing states to better support Medicaid long-term services and supports beneficiaries in transitioning from institutions back to the community. This report highlights 2013 MFP enrollment and spending trends and services and supports offered across state MFP demonstrations.

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The Henry J. Kaiser Family Foundation

Money Follows the Person: A 2015 State Survey of Transitions, Services, and Costs

The Money Follows the Person (MFP) demonstration provides enhanced federal matching funds, allowing states to better support Medicaid long-term services and supports beneficiaries in transitioning from institutions back to the community. This report highlights 2015 MFP enrollment and spending trends and services and supports offered across state MFP demonstrations.

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