Money Follows the Person is a federally funded national demonstration program that seeks to help people receiving Medicaid transition from institutions, such as nursing facilities, to home and community-based services. In addition to offering more independence and a potentially better quality of life for people receiving Medicaid benefits, the program shifts spending from costlier institutional care to potentially less expensive home and community-based services.
Since 2001, when Texas first pioneered Money Follows the Person as a state initiative, thousands of Texans have transitioned to home and community-based services. However, people with serious mental illness and substance-use disorders experienced additional barriers in making that transition.
From 2008 to 2017, Texas operated a Behavioral Health Pilot (BHP) program in several Central Texas counties that integrated mental health and substance abuse services with home and community-based services. The BHP targeted adults who had lived in nursing facilities for at least three months, met nursing facility medical criteria and had a serious mental illness. The BHP pioneered evidence-based rehabilitative practices and other supports that helped over 450 people with serious mental illness leave nursing facilities and live successfully in the community.
Services, such as Cognitive Adaptation Training (CAT), help empower people to take charge of their lives and reach their full potential. CAT provides assistance and environmental modifications to help people establish daily routines, organize their home and hone their community living skills. Pilot program substance abuse services included individual counseling, group therapy, connection to other community programs and fostering peer support.
Pilot services were available to participants for up to six months before being discharged from a nursing facility and up to one year after they were relocated into the community. Home and community-based services were provided through STAR+PLUS, a Medicaid program overseen by a managed care organization (MCO). STAR+PLUS services continued after the pilot program services ended for each participant.
People in the BHP showed improved and sustained functioning and quality of life. The BHP also saved an estimated $24.5 million in Medicaid costs within the counties that participated in the pilot program. Almost 70% of those who left nursing facilities under the pilot successfully maintained independence in the community. Examples of increased independence included getting a job at a competitive wage, driving to work, volunteering, getting a general equivalency diploma (GED), teaching art classes, leading substance use peer support groups and working toward a college degree.
Sustaining the Gains, Improving the System
Since 2018, Texas has worked to sustain and spread successful relocation and diversion practices throughout the state. HHSC provides training and technical assistance to STAR+PLUS MCOs and their network providers, local mental and behavioral health authorities, long-term care providers and others through the International Center of Excellence for Evidence-Based Practices at the University of Texas Health at San Antonio. For more information, visit the International Center of Excellence for Evidence Based Practices. HHSC staff have also reviewed agency data, policies, rules and contracts to institute changes that help in sustaining successful transition practices.
In 2021, HHSC received additional MFP-related funds to implement new pilot programs in Central Texas, which expand infrastructure to support transitions to home and community-based care. One pilot program set for implementation in fiscal year 2024 will provide state psychiatric hospital patients who have long-term care needs with intensive behavioral health and peer support services before and after they transition to home and community-based care. Another new pilot, implemented in fiscal year 2023, provides a dedicated position within MCOs to help transition people with serious mental illness from nursing facilities.
Presentations and Articles
- Finding Your Center of Excellence: Implementing Best Practices (PDF)
- Money Follows the Whole Person in Texas by Dena Stoner and Marc S. Gold, Journal of the American Society for Aging (Spring/Winter 2012)
Texas strives to equip professionals with resources and knowledge to implement evidence-based transition practices, such as CAT, in their practice as they assist people experiencing severe mental illness who are relocating from a nursing facility to community living. Online and in-person workshops are available via the International Center of Excellence for Evidence-Based Practices.
- CAT is an evidence-based intervention that uses a motivational and empowering perspective to facilitate a person’s initiative and independence. The linked resource page provides video examples, training resources for practitioners and STAR+PLUS billing guidance.
To learn more about MFP: Behavioral Health initiatives, email Innovation Strategy.