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Money Follows The Person (MFP)

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There's good news for Nevada residents currently living in nursing homes or in other institutional settings who want to move back home. Through the Money Follows the Person (MFP) Transitioning Home program, a new offering from the State of Nevada, eligible participants will be provided with the services, support, and assistance necessary to move back into a community setting, such as an apartment or family home.

In order to help eligible participants with the transition process, the program can pay for goods and services, such as furniture, appliances, moving expenses, and housing deposits. See the SERVICES tab for a full list of program benefits.

MFP also gives most participants the option of self-direction, allowing them to decide where they want to live and who will assist them upon returning to the community.

Program Info

Elderly man with caregiver

Program Information

Overview

The Money Follows the Person (MFP) Transitioning Home program is a state-wide program operated by the Division of Health Care Financing and Policy (DHCFP) that gives Nevadans currently residing in nursing homes or other institutions the opportunity to transition back into their respective communities.

The program provides eligible participants with community-based services and the support needed to remain independent. An important component of MFP is that participants have the choice to self-direct their own services — decide where they live and who will assist them in the community.

More than 31,000 people with chronic conditions and disabilities have transitioned from institutions back into the community through MFP programs as of December 2012, according to the soon to be released semi-annual progress report. The Affordable Care Act of 2010 strengthened and expanded the MFP program allowing more states to apply. Currently, 45 states and the District of Columbia have MFP programs.


Purpose

Money Follows the Person aims to increase the use of qualified home- and community-based services and reduce the use of institutionally-based services, and ensure that Nevadans receive care in the community, which helps fulfill the state's commitment to making sure residents who need services can live as independently as possible.

Most people who need long-term services would prefer to receive care in their community, rather than having to move into a nursing facility or institution. Expanding home- and community-based services gives more Nevadans care in the setting they prefer and provides support for informal caregivers.

And it turns out that in Nevada, providing home- and community-based services is the cost effective option. Investing in home- and community-based care has been shown to save states money. Average Medicaid spending on non-institutional care for seniors and people with physical disabilities can be as much as 85 percent less per person than nursing home care, according to findings in several reports.1

1 Families USA report: Health Reform: New Opportunities for States to Invest in Home- and Community-based Services; and Kaiser Families Foundation report: Medicaid's Long-Term Care Users: Spending Patterns Across Institutional and Community-based Settings.

Eligibility

Asian couple and house

Eligibility

To qualify for the MFP program, the following criteria must be met:

  • Individuals must be eligible for Medicaid
  • Individuals must have lived in a nursing facility or qualified institution for at least 90 consecutive days (excluding short-term rehab)
  • Medicaid must pay for at least one inpatient day in the qualified institution
  • Individuals must have medical needs that can be met by services available in the community

There are no age-based restrictions.

If you don't meet the eligibility for Transitioning Home, Nevada's FOCIS unit may still be able to assist you transition back into the community. See MORE INFO tab.


Qualified Residence requirement

In order for an eligible transition through MFP, a participant must be transferred from a nursing facility or institution to a qualified residence, which is defined as:

  • A home owned or leased by the individual or a family member
  • An apartment with:
    • an individual lease
    • living, sleeping, bathing, and cooking areas that the resident has domain and control over
    • lockable access and egress
  • A residence in a community-based residential setting in which no more than four unrelated individuals reside

Group homes and assisted living facilities are NOT qualified residences, UNLESS it is an assisted living facility in which:

  • occupancy is governed by an individual lease
  • the unit has living, sleeping, bathing, and cooking areas
  • the unit has lockable access and egress
  • occupancy does not require that services be provided as a condition of the lease

Services

Services

The services offered through Money Follows the Person (MFP) Transitioning Home aim to provide the supports necessary for participants to successfully move back into the community and remain healthy and independent following the transition. Available services include:

Community-based Services

Most participants will have access to community-based services, including, but not limited to:

  • Personal care service — Provided to eligible recipients whose chronic health problems cause them to be functionally limited in performing activities of daily living. Personal care services include but are not limited to: assistance with eating, bathing, dressing hygiene, shopping, laundry, meal preparation, chores, etc.

  • Home health services — May be provided on an intermittent basis to eligible recipients based on medical necessity and physician authorization. Services include: Skilled nursing, physical therapy, occupational therapy, speech therapy, and home health aides.

  • Durable Medical Equipment (DME) — Equipment and supportive devices used to serve a medical purpose; this includes prosthetics and orthotics.

  • Adult Day Health Care (ADHC ) — ADHC facilities provide a daytime care environment where eligible participants (who meet the Level of Care criteria) will receive medical services and oversight, in addition to social, health and nutrition services.

  • Personal Emergency Response System (PERS); also known as Medical Emergency Response Systems — An electronic device that allows you to call for help in an emergency by pushing a button. PERS will be provided to all MFP participants to serve as a 24-hour back-up system.

  • Non-emergency medical transportation — Transportation to medical appointments.


Community Transition Services

One of the truly unique benefits of the MFP program is the offering of Community Transition Services. Funding will be made available for goods and services necessary for a participant's transition back to the community and to establish a household. These services are provided on a one-time basis and are only available within the first year following transition. Community Transition Services include, but are not limited to:

  • Housing deposits
  • Set-up fees for essential services and utilities
  • Household furniture and appliances
  • Bank set-up fees and deposit
  • Moving expenses
  • Cleaning costs
  • Essential groceries

Transition Navigation

All participants transitioning to the community will have access to a state Health Care Coordinator, who will manage the transition process. The coordinators will identify participants' needs and work to assist them in realizing their goals of moving back into the community.

Coordinators will also help participants develop a transition plan with their families and the nursing facility staff, find benefits, assist with housing resources, and link with community services. Coordinators will continue to provide assistance for up to one year following a participants' transition.


Home Modifications & Adaptations

To ensure the health, welfare and safety of participants following transition, modifications and adaptations can be done to a participants dwelling. Examples include, but are not limited to:

  • Modifications to bathroom facilities
  • Ramps
  • Hoyer lifts
  • Grab bars
  • Stairlifts

Multimedia

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Testimonials

Testimonials

Paula S. - An MFP Success Story

Paula Smolenski


“I’m so thankful for all the help I was able to get through the MFP program. It was a real blessing. Everyone involved has been so wonderful. They’re so caring and invested in making sure I succeed.”

For a little more than a week, the ceiling above Paula’s bathtub in her apartment was leaking. It was nothing major, but a leak nonetheless. And it took her apartment maintenance crew a few visits to get it completely fixed. But it didn’t bother Paula much.

Sure, she would have preferred not to have the leak, but it was a fairly minor nuisance. In a sense, it was almost a welcomed nuisance – as much as a leaky ceiling can be, anyways – because it was a leak in Paula’s ceiling. Above Paula’s bathtub. In Paula’s apartment. An apartment in which she is free to come and go, and decorate, and cook.

Paula has come to appreciate independence and all that comes with it – including leaky ceilings – a bit more since spending nearly 11 months in and out of hospitals and a skilled nursing facility between November 2011 and November 2012.

With assistance from the Money Follows the Person (MFP) program, Paula was able to transition from the nursing home back into the apartment she had been sharing with Patricia, a long-time friend who she considers a sister.

“I’m so thankful I have my freedom and have been able to get back into life,” said Paula. “I can go out when I want to now and spend time with my friends.”

When Paula and Patricia moved to Las Vegas from Passaic, New Jersey in August 2011, they were looking for a fresh start. Both had just lost their fathers, and their mothers had both recently been placed in nursing facilities.

And considering that New Jersey Governor Chris Christie had just declared a state of emergency and advised many of the Garden State’s residents to evacuate in preparation for Hurricane Irene’s arrival, it seemed like perfect timing.

Life in Las Vegas got off to a good start for the two. Both had transferred from their respective jobs in New Jersey and started working their new positions. On days off, they were also enjoying the Vegas life.

Things, however, took an unexpected turn that November when Paula – who until then had not known she was diabetic – was admitted to the hospital after her left foot began to swell and turn colors. She rushed into surgery where she had to have her left leg amputated at the ankle. After nearly two months of intensive rehab, she was able to move back home.

But less than three months later, Patricia found Paula unresponsive in bed, just a day after she had been sent home from the emergency room after doctors thought she had a diabetic attack. Paula was rushed back to the emergency room where it was determined that she had suffered a stroke.

“I was scared,” recalled Patricia. “I didn’t know if she was going to survive it.”

But Paula did survive. However, the stroke left her with limited speech, mobility, and motor skills. She spent the next several months in a rehabilitation facility where she was able to regain her speech and worked to regain her motor skills.

In May 2012, she was transferred to a skilled nursing facility where she lived for the next seven months. For Paula, the time she spent in the facility was a difficult and trying period.

“I did not enjoy it there,” she said. “My bed was uncomfortable, most of the food was lousy, and I didn’t have much freedom, which was the worst part. I couldn’t do what I wanted to do; I couldn’t live my life.”

However, not long after transferring to the facility, Paula learned that she might be a candidate for MFP from a transition specialist with the program. Though excited by the prospect, she was initially apprehensive about the idea of moving back into the community.

“I was worried that I wouldn’t be able to get along because I wasn’t yet sure of myself. I was still learning how to do things like stand and walk and move around,” Paula said.

But after weighing her options, Paula decided to pursue assistance through the program.

Prior to leaving the facility, her MFP transition coordinator helped her apply for a Medicaid waiver program and worked to purchase some household furniture and adaptations to make it easier for Paula to move around the apartment in her wheelchair.

In November 2012, after everything was in place, Paula was discharged from the facility and moved back into her apartment.

“I’m so thankful for all the help I was able to get through the MFP program. It was a real blessing,” she said. “Everyone involved has been so wonderful. They’re so caring and invested in making sure I succeed.”

Since her discharge, Paula’s made an effort to control her diabetes by adopting a healthy lifestyle. The result: She’s lost 50 pounds and hasn’t had to use her insulin since returning home.

With the help of continued physical therapy, she has regained partial use of her right hand. And with assistance from her personal care attendant, she’s made progress in dressing herself.

However, there’s still more to be done. Paula has her sights set on being able to walk on her own without the aid of a walker, and also hopes to get back to work. Nothing major, she insists, just something part-time.

“I know it will take some time and patience, but it will come,” she said.

More Info

Apply Directly

To apply directly to the program, complete the MFP Referral Form and either fax or mail it to the appropriate office (listed on form), or contact one of Nevada's FOCIS units:


Contact us

To get more information about Nevada's Money Follows the Person (MFP) Transitioning Home program, contact:


FOCIS Unit

FOCIS (Facility Outreach and Community Integration Services) is a Medicaid program intended to provide Medicaid recipients with an alternative to institutional living. The FOCIS unit is staffed by social workers, nurses, and other licensed healthcare professionals whose role is to assist individuals to live in community settings by accessing Medicaid services and resources. FOCIS aims to assist individuals either at risk of long-term care facility placement, or who are currently residing in a facility. For more information on FOCIS, please call:


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