Minnesota among leaders in funding the shift to community living
Disability advocates across the nation are celebrating the recent passage of the federal Money Follows the Person legislation. “Money Follows Person” (MFP) grants appropriated in the federal Deficit Reduction Act of 2005 present an excellent opportunity for other states to follow Minnesota’s leadership in rebalancing services for people with disabilities and the elderly from institutions to home and community-based settings. MFP is an approach that has proven to meet people’s preferences and produce better individual outcomes while stretching public dollars for long-term care.
Minnesota’s progress in shifting the balance of supports for people with disabilities and the elderly away from institutions toward home and community-based settings is evidenced by several benchmarks.
• With a 40/60 ratio, Minnesota ranks fifth among all states in its percentage of public expenditures for the elderly and people with disabilities in institutional versus community-based services.
• The daily population of people under age 65 in nursing homes has decreased from more than 3,300 in 2001 to 2,250 in 2006.
• Lengths of stay in nursing facilities have decreased dramatically as more than 55 percent of people admitted to nursing homes currently are discharged in six months or fewer, compared to less than 29 percent in 2001.
For Minnesota, pursuing MFP funding would mean risking dilution of our current efforts because of the effort and expense necessary to secure, coordinate, implement and sustain new programs under the MFP grant. Instead the Department of Human Services (DHS) has elected to continue numerous MFP-like efforts to support people who want to live, work and maintain maximum independence in the community.
Key Minnesota initiatives include:
• Being among the first states to implement federally and state-funded home and community-based waiver services as well as the Alternative Care program for the elderly so that older Minnesotans and people with disabilities can receive services at home instead of in hospitals, nursing homes and other institutions. More recently, DHS has added the Community Directed Community Supports option to all of the waivers, thereby allowing individuals to hire family, friends and neighbors to help with their care.
• Offering additional senior nutrition, health promotion, transportation, chore and other targeted services to help seniors remain in their homes.
• Providing statewide information and assistance services for the elderly and people with disabilities to direct them to products and services they need.
• Implementing Medical Assistance for Employed Persons with Disabilities in 1999 to allow people with disabilities to maintain MA coverage while working, earning income and accruing assets.
• Forging new partnerships, improving coordination of services and communication, enhancing public policy and strengthening transition services and work experiences for youth and young adults with disabilities in order to increase the number of people with disabilities in competitive employment and meet Minnesota’s workforce needs. Pathways to Employment, a four-year partnership begun in 2005 with support from a federal Medicaid infrastructure grant, is conducted in partnership between DHS, the Minnesota Department of Employment and Economic Development and the Minnesota State Council on Disability.
• Launching a federally-funded pilot project, called the Demonstration to Maintain Independence and Employment (DMIE), which will run from 2006 through 2008. The DMIE provides working people with serious mental illness health care coverage and additional supports to enable them to remain employed and independent.
• Since 2001, DHS and other state agencies have made an extra push, through the Options Initiative and Options Too, to increase access to community supports for people under 65 living in or at risk of being placed in nursing homes. This drive is being supported with mandatory face-to-face consultations before people under age 65 are admitted to nursing facilities; funding and care coordination to help people relocate from nursing homes if they wish; and more flexibility, choice and control for individuals so their service needs at home can be better met.
While other states begin to take steps to reshape services for people with disabilities and the elderly, Minnesota is committed to sustaining and furthering its considerable progress in offering quality, cost-effective services where the vast majority of these populations want them.
Loren Colman is assistant commissioner for Continuing Care at Minnesota Department of Human Services.
