How to Sustain State Resources for People with Disabilities Featured at National HCBS Conference

The National Association of States United for Aging and Disabilities holds an annual National Home and Community Based Services (HCBS) Conference. The conference is for staff of Federal, State, and local agencies, as well as partners, providers and advocates providing services to people with long term services and supports (LTSS) needs in the community. 

At this year’s HCBS Conference, I had the opportunity to represent the Maryland Medicaid agency (my previous employer) on a panel presentation on how to obtain Federal funds for Aging and Disability Resource Centers (ADRCs). ADRCs are partnerships between local agencies that are also referred to as No Wrong Door agencies. In Maryland, the ADRCs are formal partnerships between the local Area Agency on Aging and the Center for Independent Living, as well as other agencies such as the local health department, local division of mental health and substance abuse, state agencies for developmental disabilities, department of social services, etc. 

ADRCs are trusted sources of unbiased information for older adults and individuals with disabilities of all ages who need LTSS.  They educate people and link them with services, helping them with applications and following up as needed. ADRCs also help individuals prepare for future needs, helping them avoid the feeling of panic in the event of a crisis. ADRCs support the Medicaid program by conducting program outreach, helping people who already qualify for Medicaid to get access to Medicaid-funded programs and services, as well as educating individuals who don’t qualify for Medicaid on how to make the best use of their own resources or other publicly funded programs, delaying entry into costly Medicaid-funded institutions. 

ADRCs don’t charge for their services and as more people turn to these Centers to help learn about and get access to LTSS, their resources, staff and budgets are stretched thin, increasing the risk of not being able to meet the needs of those seeking help.  That’s where the Federal funds come in.  Medicaid programs are jointly funded by the State and Federal governments and the Federal funding is called Federal Financial Participation (FFP).  Medicaid programs get FFP at a rate of 50 percent for the administrative costs of running the Medicaid program.  Work done by other agencies on behalf of the Medicaid agency can be eligible for FFP if certain criteria are met. The concept of ADRCs receiving FFP is a new for many States and it was exciting to share how Maryland structured its plan for ADRC FFP. As the result of several years of work, Maryland is now positioned to grow the ADRC network with an ongoing source of sustainable funding.

Our panel presentation on sustaining ADRC work through FFP was scheduled for the final breakout session time slot of the conference. Looking back, that made a fitting end. On the first day of the conference, New Editions hosted the Money Follows the Person (MFP) Intensive, an all day program of speakers, panel presenters, and small group discussions among peers. The topic:  Sustainability. 

The MFP program is a Federal demonstration program designed to help individuals transition from institutions back to the community and to rebalance LTSS systems. There are currently 43 states and the District of Columbia participating in this program. Every state implements the MFP program a little differently to best meet the needs of their population. States earn rebalancing funds (enhanced Federal funding) based on the number of individuals that transition and the home and community-based services they receive during their MFP participation year. Rebalancing funds must then be used to increase access to home and community-based services, which can include building community infrastructure and capacity. 

Through the end of 2015, MFP States had transitioned more than 63,000 individuals. Though still a couple years out, the end of the demonstration program is in sight and States are working on sustainability plans to continue supporting transitions and make use of lessons learned by integrating MFP services into each state’s existing programs. During the Intensive, MFP project directors shared how they used partnerships and rebalancing funds to plan for sustainability in program activities and key staffing. 

In Maryland, a lot of the initial MFP work to conduct outreach and provide education and application assistance to nursing facility residents is done through ADRCs. It was important for MFP to invest in building these partnerships, as well as developing a sustainability plan to ensure the infrastructure developed during the MFP demonstration would continue after the funding ended. By securing FFP for the ADRCs, Maryland has secured an ongoing source of funding for the ADRCs after MFP ends.

I have been fortunate to attend this conference many times over the years and my favorite part has always been talking with people about the programs they work on and the strategies they are using to improve them to better serve individuals that need LTSS. It is energizing to be among and learn from so many people that are dedicated to improving the lives of older adults and people with disabilities.  

Devon Mayer is a Senior Policy Analyst at New Editions Consulting, Inc. who provides technical assistance for the Money Follows the Person (MFP) Demonstration. MFP helps people move out of nursing facilities and other institutions, back to the community. Ms. Mayer previously worked for the Maryland Medicaid agency where she managed programs that expand community-based long term services and supports for older adults and people with disabilities.