Money Follows the Person Demonstration Project

The Centers for Medicare & Medicaid Services (CMS) sponsors the Money Follows the Person demonstration project to support state efforts to increase the use of community-based settings rather than institutional settings for providing long-term services and supports under the Medicaid program.

Since its inception, Money Follows the Person has helped over 49,000 Texans move back to their communities after living in an institutional setting. The project helps increase the use home and community-based services (HCBS) such as bathing, eating and dressing that allow people to live safely in their communities.

From 2009 to 2023, Texas has reduced the portion of long-term services and supports (LTSS) expenditures for institutionally based services by nearly 20%. Texas also increased the portion of LTSS expenditures on HCBS from 47% in 2009 to 66% in 2020. Community-based services now account for most of the state’s LTSS expenditures.

Money Follows the Person is part of the Promoting Independence Initiative, which is the state’s response to the U.S. Supreme Court’s decision in Olmstead v. L.C., 119 S. Ct. 2176 (1999). The initiative uses state general revenue to provide community-based services in the most integrated setting, within certain limitations.

The chart below shows the impact of Money Follows the Person 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 Money Follows the Person demonstration, Texas receives enhanced FMAP for services approved by CMS. FMAP is used to determine the amount of matching funds states receive from the federal government for services provided through Medicaid. Enhanced FMAP reduces the percentage contributed by the state, thus generating cost savings for Texas.

Promoting Independence and MFP Demonstration Transitions 2008-2023

Source: “10 MFPD New Participants by Target Population,” Health and Human Services Commission Quality Assurance and Improvement DataMart. Report generated May 20, 2024.

Annual Money Follows the Person Federal Grant

In calendar year 2023, 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 supported:

  • Behavioral health services that help people remain in the community.
  • Integrated employment that promotes greater self-sufficiency.
  • Community-based supports to persons with intellectual and developmental disabilities who have complex medical and behavioral health needs.

Programs for Rental Assistance

HHSC 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 Program (PRA) provides project-based rental assistance for people with disabilities who have extremely low incomes. Rental assistance is available in Section 811 PRA housing areas located in eight regions of the state. The program has helped over 700 people with rental assistance since its inception in 2016.

TDHCA also operates Project Access, a rental assistance program that provides housing vouchers to low-income people transitioning from nursing facilities back to their communities. These housing vouchers allow people to rent privately owned housing at a lower cost. Since its inception in 2001, the program has helped 2,196 people with rental assistance.