Adult Medicaid Manual MA-2280 COMMUNITY ALTERNATIVES PROGRAM (CAP)

VIII. MONEY FOLLOWS THE PERSON

The Division of Medical Assistance received a demonstration grant to institute the Money Follows the Person Program (MFP). MFP is intended to transition individuals from institutions who want to live in the community, and provide quality programs and services that are person-centered, appropriate and needs based in both home and community-based settings.

In order to be eligible, MFP applicants must meet all the eligibility criteria for enrollment in CAP/Choice, CAP/DA, CAP-MR/DD or the Program for All-Inclusive Care for the

Elderly (PACE) in addition to criteria unique to the MFP Program. Individuals transition into a CAP waiver program or PACE on their first day in the community. Slots have been reserved in each CAP waiver program for MFP participants.

Potential MFP recipients will be identified by a regional Transition Coordinator, who will work closely with the facilities, the recipient, the families and the county dss. The

Transition Coordinator coordinates with the county dss to ensure that the individual will remain Medicaid eligible when transitioned into MFP. MFP includes coverage of all CAP services plus some additional services, MFP is available statewide.

A. DSS Responsibilities

1. The county dss is responsible for determining eligibility for the appropriate CAP program.

a. CAP/Choice

b. CAP/DA

c. CAP-MR/DD

d. Program of All-Inclusive Care for the Elderly (PACE)

2. If an individual or his personal representative expresses interest in applying for MFP and the individual is not currently Medicaid eligible, take and process an application the same way you would a CAP case. If the applicant has not been referred to the local lead agency or Local Management Entity or PACE organization by the MFP Transition Coordinator, contact the MFP Program Coordinator at (919) 855-4270 and inform him that a Medicaid applicant has expressed interest in MFP.

3. Budgeting

Follow current CAP policy for all eligibility requirements and budgeting.

NOTE: A Special Use code of “MF” and begin and end dates will be entered by DMA.

REISSUED 11/01/11 -CHANGE NO. 17-11

(VIII.)

B. Transition Coordinator Responsibilities

1. Screen MFP applicants for all MFP eligibility criteria. To be eligible to participate in MFP an individual must:

a. Receive inpatient services paid for by Medicaid in qualified institutions that serve individuals who are elderly, disabled or developmentally disabled, and

b. Have resided in an institution for a minimum of six months, and

c. Continue to require the level of care provided by the institution, and

d. Meet the criteria for enrollment in CAP/Choice, CAP/DA, CAP-MR/DD or in the Program of All-Inclusive Care for the Elderly (PACE), and

e. Be moved into a qualified residence in the community.

2. Coordinate with county dss to ensure that the individual will remain Medicaid eligible when transitioned into MFP.

3. Verify that the individual has been in an appropriate facility for at least a six month period.

4. Inform the individual, his legal guardian, and identified family members that an MFP recipient with a CAP deductible will be responsible for paying for MFP and CAP services until his monthly deductible is met

5. Contact the local lead agency or Local Management Entity or PACE organization to begin the process of assessing, determining eligibility, and development of the plan of care/person centered plan.

6. Develop an MFP Transition Plan.

7. Inform the individual, his legal guardian, and identified family members of policy regarding protection from abuse, neglect, and exploitation.

8. Train the individual, his legal guardian, and identified family members in responding and reporting critical incidents and other processes.

REVISED 10/01/11 – CHANGE NO. 17-11

(VIII.)

C. MFP Individual Moves to Another County

1. MFP recipient moves

An MFP recipient, who moves from one county to another, remains MFP eligible.

2. PACE/MFP recipient moves

A PACE/MFP recipient who moves to another county may no longer be PACE and MFP eligible (see MA-2275, Program of All-Inclusive Care for the Elderly (PACE). The individual must be evaluated for CAP eligibility in the new county. If the individual is found eligible for CAP in the new county MFP eligibility may resume.

3. CAP county transfers

See III.J for reference to county transfer instructions for the CAP program.