The Centers for Medicare and Medicaid (CMS) sponsors the Money Follows the Person Demonstration (MFPD) to support state efforts to rebalance their long-term services and supports system so that people have a choice of where they live and receive services. Since its inception, the program has helped over 44,000 Texans move from institutions to the community. MFPD helps Texas increase the use of home and community-based services (HCBS) and reduce the use of institutionally-based services. HCBS helps people with self-care tasks such as bathing, eating, and dressing, and enables people to live safely in the community.
Over the past 11 years, Texas has reduced the portion of LTSS expenditures that support institutionally based services from 53 percent in 2009 to 35 percent in 2020. At the same time, Texas increased the portion of LTSS expenditures on HCBS from 47 percent in 2009, to 65 percent in 2020. Community-based services now account for the majority of the state’s LTSS expenditures.
MFPD is part of the state’s Promoting Independence Initiative, the state’s response to the supreme court Olmstead decision (119 S.CT. 2176). Promoting Independence uses state general revenue to provide community-based services in the most integrated setting, within certain limitations.
The chart below shows the impact of MFPD and Promoting Independence in Texas and the number of people who transitioned from institutions to community-based settings by year. These transitions were supported with grant funds and enhanced Federal Medical Assistance Percentage (FMAP), which is the share of Medicaid costs covered by the federal government.1
1Under the MFPD, Texas receives enhanced Federal Medical Assistance Percentage (FMAP) for services approved by CMS. FMAP is the percentage rate used to determine the amount of matching funds states receive from the federal government for Medicaid funded services. Enhanced FMAP reduces the percentage contributed by the state, thus generating a cost savings for Texas.
Promoting Independence and MFP Demonstration Transitions 2008-2021
Most recent MFPD Grant
In calendar year 2021, HHSC received over $28 million in federal funds to help people transition out of nursing facilities, state supported living centers, intermediate care facilities for individuals with intellectual disabilities, and other institutions. Funds also support behavioral health services that help people remain in the community, integrated employment that promotes greater self-sufficiency, and community-based supports to persons with intellectual and developmental disabilities who have complex medical and behavioral health needs.
The Health and Human Services Commission also collaborates with the Texas Department of Housing and Community Affairs (TDHCA) to provide affordable, accessible, and integrated housing for persons transitioning from institutional settings. The Section 811 Project Rental Assistance (PRA) program is a federally funded program that pays part of a tenant’s rent, based on income, making their housing more affordable. The rental housing support is available in Section 811 PRA housing, located in eight regions of the state. The program has housed over 600 people since it began in 2016.
TDHCA also operates Project Access, a rental assistance program that provides housing vouchers to low-income people transitioning from nursing facilities. These housing vouchers allow people to rent privately owned housing in the community at a lower cost. Thus far, the program has helped 1,761 people.