Money Follows the Person

Quarterly Stakeholder Meeting
June 25, 2013 

Agenda
•	Welcome
•	MFP Staff Update
•	MFP Data
•	MFP Housing Update
•	MFP Waivers

MFP Demonstration Benchmark Data

Graph showing the number of MFP participants in the community by population as of 5/31/2013

•	202 elders
•	29 individuals with ID/DD
•	80 individuals with physical disabilities 
•	13 individuals with mental illness 

Graph showing the number of transitions by type of community residence 5/31/2013

•	60 individuals to homes owned by the participant 
•	61 individuals to homes owned by a family member 
•	118 individuals to apartments leased by participant
•	1 individual in assisted living
•	84 individuals to group homes of 4 persons to less

Graph showing the number of MFP participants in the community by qualified facility 5/31/2013

•	285 individuals from Nursing Facilities
•	16 individuals from ICF/MR
•	23 individuals from Chronic or Rehab Hospitals

MFP Housing Strategies

MFP Participants’ Housing Needs

MFP Enrollees will transition to the community into MFP qualified residences – either by:

•	Returning to existing homes/housing;

•	Moving into a group home or other supported residential setting; OR

•	Seeking new housing – the topic of this presentation

MFP Qualified Residences

In the MFP Demonstration, a Qualified Residence is:

•	a home owned or leased to the individual or family member;

•	an apartment with the individual holding the lease with a lockable entrance and control and domain over living, sleeping, bathing and cooking areas; cannot require acceptance of services as a condition of tenancy; or

•	a community based residence with no more that 4 unrelated individuals.

Focus of this presentation will be on those choosing the option to live in an apartment setting.

MFP Demonstration Support for Housing Goals

•	MFP Strategic Housing Partnership Coordinator
•	5 Regional Housing Coordinators within Regional Housing Network Entities
•	Housing Search Entities
•	Adaptive Services Coordinator
•	One time set up expenses such as: furniture, bedding, security deposit, service installation

MFP Strategic Housing Partnership Coordinator

•	Individual at the state level responsible to develop ideas, strategies and partnerships that support the development of new housing opportunities for MFP Participants with input from the Regional Housing Coordinators.

•	Oversee the implementation of the 811 Project Rental Assistance grant for EOHHS.

Regional Housing Coordinators

A contracted position working within the Regional Housing
Network whose primary responsibilities will be to:

•	develop affordable, accessible housing opportunities for MFP participants in their designated region;
•	track and report the number of these units in the region to meet MFP goals;
•	ensure, confirm and track that such identified units meet the MFP definition of qualified residences;
•	engage and establish on-going relationships with local and regional entities that administer/manage affordable housing opportunities; and
•	coordinate 811 program referrals at the regional level.

Massachusetts Regional Housing Network

For 30 years, nine regionally based non-profit member agencies of this network have championed the value of working on a regional level to address the needs of their constituents. They:

•	engage policy makers, landlords, community leaders, and investors to protect and to create affordable housing;
•	are efficient innovators, committed to restoring housing choice, and returning every Massachusetts family home;
•	consistently identify regional issues and work collaboratively with one another, as well as local government officials, local housing authorities, private landlords, private housing developments and other agencies working on housing concerns to find regional solutions to those issues;

Regional Housing Network (continued)

•	cover the Commonwealth and available to all 351 cities and towns for assistance with housing development, management, and policy setting. All of this is in addition to their core work of implementing and managing innovative and traditional housing programs designed to assist people of all income levels;
•	manage over 19,000 Housing Choice Vouchers which allows low income families and individuals to live in decent, safe and sanitary housing;
•	work housing homeless families on behalf of the Commonwealth; and
•	will administer the 811 Project Rental Assistance vouchers on behalf of DHCD.

Housing Search Entities

•	An MRC-qualified person or organization that specializes in securing affordable homes or apartments for MFP eligible participants.
•	Currently 6 organizations have been qualified to provide housing search activities. Two additional organizations are in the process of being qualified, and two more proposals are under review. Contracts for qualified HSEs are in process.
•	Open, rolling procurement on Comm-PASS.
•	Payment of $1000 with $400 for initial tasks and $600 at placement.
•	Contact Nina Rosenberg at MRC at (617) 204-3827 for more information.

HSE Qualified Entities
•	Must have successful experience assisting elders and/or individuals with disabilities to secure affordable & accessible housing.
•	Must demonstrate knowledge of:
•	Local public and private housing resources
•	State & federal housing programs.
•	Must work closely with MFP participants, transition coordinators & case managers to ensure complete and timely housing applications.
•	Will coordinate with Regional Housing Coordinators on housing options developed through the regional networks.

Qualified Housing Search Entities

•	Advocates – Greater Boston, Central, Southeast Regions
•	AIDS Action Committee – Greater Boston Region
•	Hearth, Inc. – Greater Boston Region
•	Housing Assistance Corporation – Greater Boston Region
•	Metropolitan Boston Housing Partnership – Greater Boston
•	South Middlesex Opportunity Council – Central Region

This RFQ is open for interested applicants – additional HSEs will be qualified on an on-going basis.

Relationship of Transition Coordination Entities, Housing Search Entities and Regional Housing Coordinators

•	The Transition Coordinator (TC) will assist the MFP participant to select a Housing Search Entity (HSE) from the qualified pool when the individual identifies an apartment or rental unit as their choice of “qualified residence.”

•	The TC completes and sends a simple referral form to the selected HSE and a copy to the Regional Housing Coordinator.

•	If the referral is accepted by the HSE, then they will complete a more comprehensive Housing Needs and Preferences assessment to identify needs and any barriers to securing housing.

Relationship of Transition Coordination Entities, Housing Search Entities and Regional Housing Coordinators (continued)

•	TC assists the participant in completing required forms and gathering documentation as part of the Housing Search process.
•	The HSEs and RHCs will regularly share all housing options that have been or are under development within the region for MFP participants.
•	The HSE will work with the TC and participant to follow up on recommended options.
•	TC, HSE  and RHC will be in regular communication until the individual is successfully housed in the community.

Adaptive Services Coordinator

•	Staff of Mass. Rehab Commission’s Waiver Unit.
•	Manages all major home accessibility modification projects for MFP participants.
•	Coordinates projects with MFP participants, their transition coordinators and case managers and all other involved parties.
•	MFP home modifications may be available only for MFP qualified residences, but not including staffed residential programs.

Housing Tools

•	MFP Housing Needs and Preference Tool
•	MFP Housing Search Entity Manual
•	UMASS On-line Training Resources
•	MassAccess Housing Registry
•	MassHousing Directory

Training will be available for TCs and HSEs

Housing Strategies

Use of Existing State and Local Housing Targeted Resources
•	Community Based Housing
•	Facilities Consolidated Fund (DDS and DMH)
•	Non elder Vouchers through Lynn Housing Authority
•	Mass Housing Set aside (DDS and DMH)
•	Home Modification Loan Program
•	Supported Housing Program (EOEA)
•	Assisted Living (those that meet MFP criteria)
New Resources
•	Section 811 Project Rental Assistance
•	MFP funds for access modification & one time setup costs

Projecting Need

•	Using data from Mathematica 2011 Annual Report for all MFP States
•	Using MA MFP target of transitioning 2,192 individuals:
•	1,358 elders
•	510 with physical disabilities
•	182 with mental illness
•	142 with intellectual disabilities

Applying Mathematica Averages*

Chart showing the percent of MFP participants in the community by type of qualified residence. The data was gathered nationally by Mathematica and shows all MFP projects through 2011. 

Overall percent of MFP participants in homes owned by self or family member: 28.7%
Overall percent of MFP participants in apartments: 30.4%
Overall percent of MFP participants in assisted living: 9%
Overall percent of MFP participants in group homes: 19.9%
Overall percent of MFP participants whose residence is unknown: 11.9%

Percent of elders in homes owned by self or family member: 44.3%
Percent of elders in apartments: 23.9%
Percent of elders in assisted living: 13.6%
Percent of elders in group homes: 7.3%
Percent of elders whose residence is unknown: 10.9%

Percent of participants who are physically disabled in homes owned by self or family member: 31.2%
Percent of participants who are physically disabled in apartments: 43.5%
Percent of participants who are physically disabled in assisted living: 8.1%
Percent of participants who are physically disabled in group homes: 7.4%
Percent of participants who are physically disabled whose residence is unknown: 9.8%

Percent of participants who are intellectually disabled in homes owned by self or family member: 3.7%
Percent of participants who are intellectually disabled in apartments: 15.1%
Percent of participants who are intellectually disabled in assisted living: 5.4%
Percent of participants who are intellectually disabled in group homes: 71.4%
Percent of participants who are intellectually disabled whose residence is unknown: 4.5%

Percent of other participants in homes owned by self or family member: 31.9%
Percent of other participants in apartments: 10.6%
Percent of other participants in assisted living: 5.9%
Percent of other participants in group homes: 12.3%
Percent of other participants whose residence is unknown: 39.3%

Percent of unknown participants in homes owned by self or family member: 15.8%
Percent of unknown participants in apartments: 28.1%
Percent of unknown participants in assisted living: 6.3%
Percent of unknown participants in group homes: 16.4%
Percent of unknown participants whose residence is unknown: 33.4%

Applying Mathematica Averages to Massachusetts MFP Projections

Chart showing the number of MFP participants in Massachusetts by type of qualified residence using figures determined by Mathematica  

Total number of elderly participants who live in the community: 1358
Number of elderly participants in homes owned by self or family member: 601 
Number of elderly participants in apartments: 324
Number of elderly participants in assisted living: 176
Number of elderly participants in group homes: 99
Number of elderly participants whose residence is unknown: 148

Total number of participants who are physically disabled who live in the community: 510
Number of participants who are physically disabled in homes owned by self or family member: 159
Number of participants who are physically disabled in apartments: 221
Number of participants who are physically disabled in assisted living: 41
Number of participants who are physically disabled in group homes: 37
Number of participants who are physically disabled whose residence is unknown: 49

Total number of participants who are intellectually disabled who live in the community: 142 
Number of participants who are intellectually disabled in homes owned by self or family member: 5
Number of participants who are intellectually disabled in apartments: 21
Number of participants who are intellectually disabled assisted living: 7
Number of participants who are intellectually disabled group homes: 101
Number of participants who are intellectually disabled whose residence is unknown: 6

Total number of participants with mental illness/other who live in the community: 182
Number of participants with mental illness/other in homes owned by self or family member: 58
Number of participants with mental illness/other in apartments: 19
Number of participants with mental illness/other in assisted living: 10
Number of participants with mental illness/other in group homes: 22
Number of participants with mental illness/other whose residence in unknown: 71

Total number of participants in the community: 2192
Total number of participants in homes owned by self or family member:  823
Total number of participants in apartments: 585
Total number of participants in assisted living: 234
Total number of participants in group homes: 259
Total number of participants whose residence is unknown: 274

Next Steps

•	Finalize and release RHC RFR - target for July 15th
•	Finalize HSE Training Manual – target for July 12th
•	Outreach to entities to respond to HSE RFR - quarterly, most recent one done in May
•	Qualify new responses to HSE RFR-on-going
•	Orientation for new MFP Strategic Housing Partnership Coordinator – target  by August 15th
•	Update of all prior housing related materials to correct for new transition coordination model- August 30th

Next Steps (continued)

•	Gather housing needs data from enrollees-monthly
•	Collaborate with DHCD on the roll out of the 811 PRA funded units once Cooperative Agreement signed between DHCD and HUD-meetings every 2 weeks
•	Provide training to Transition Coordination, HSE and Regional Housing Coordination entities-, target by October 30th
•	Provide training to entities making referrals to 811 program- TBD

Discussion

MFP Waivers

MFP Waivers Implementation – Topics

•	Outline initial approach to implementing MFP waivers
•	Describe the MFP waivers and the waiver services offered
•	Provide information on how to access the MFP waivers

MFP Waivers- Implementation

Short term approach:

■	Conduct eligibility determinations and case management using the UMass Waiver Unit
■	Build on existing ABI waiver service providers
■	Ramp up over the next 6 months

Longer term:

■	MRC and DDS will do case management – based on the Hutchinson settlement agreement
■	Will clarify timing of these changes as we go forward

Money Follows the Person Waivers

MassHealth has two new 1915(c) HCBS waivers.

•	MFP Community Living (MFP-CL) Waiver
•	For participants who do not need 24 hour supports or supervision
•	Provides access to a variety of community-based waiver services

•	MFP Residential Supports (MFP-RS) Waiver
•	Participants who require supervision and staffing 24/7 and receive services in provider-operated and staffed settings
•	Residential habilitation in a group home serving no more than 4 individuals
•	Assisted living services
•	Shared living

MFP Waiver Eligibility

Applicants must:
•	Be living in a nursing home or long-stay hospital for at least 90 consecutive days, excluding Medicare rehabilitation days;
•	Be 18 years old or older and have a disability, or be age 65 or older;
•	Meet the requirements for participation in the MFP Demonstration, including transitioning to an a MFP qualified residence in the community;
•	Be able to be safely served in the community within the terms of the waiver.

MFP Community Living Waiver Services

•	Adult Companion
•	Chore Service
•	Community Family Training
•	Day Services
•	Home Accessibility Adaptations 
•	Home Health Aide
•	Homemaker
•	Independent Living Supports
•	Individual Support and Community Habilitation
•	Occupational Therapy
•	Peer Support
•	Personal Care
•	Physical Therapy
•	Prevocational Services
•	Respite
•	Shared Home Supports
•	Skilled Nursing
•	Specialized Medical Equipment
•	Speech Therapy
•	Supported Employment
•	Supportive Home Care Aide
•	Transportation
•	Vehicle Modification

MFP Community Living Waiver 

•	The MFP-CL Waiver is for participants who do not need 24 hour supports or supervision

•	Service Limit of 12-hours per day on the following services, separately, or in combination:
•	Homemaker
•	Home Health Aide
•	Personal Care
•	Adult Companion
•	Individual Support and Community Habilitation
•	Supportive Home Care Aide

MFP Residential Supports Waiver Services

•	Residential Habilitation (group home) 
•	Shared Living- 24 Hour Supports
•	Assisted Living Services
•	Day Services
•	Home Accessibility Adaptations
•	Individual Support and Community Habilitation 
•	Occupational Therapy
•	Peer Support
•	Physical Therapy
•	Prevocational Services
•	Residential Family Training 
•	Skilled Nursing
•	Specialized Medical Equipment
•	Speech Therapy 
•	Supported Employment
•	Transportation 

MFP Residential Supports Waiver

•	The MFP-RS Waiver is for participants who need 24 hour supervision and staffing
•	The Participant must be assessed to need a residential support service within the terms of the MFP-RS Waiver
•	Provides access to 3 types of residential supports:
•	Group Home (up to 4 people)
•	Shared Living – 24 Hour Supports
•	MFP Qualified Assisted Living

Participant Direction in MFP Waivers

The MFP Waivers will allow participant to self-direct certain waiver services
•	Employer Authority, similar to PCA program
•	Allows the participant to select, train, schedule and supervise their own worker
•	Fiscal Intermediary will process payroll including handling withholdings and tax paperwork

Chart showing self-directed services with employer authority offered in the MFP-CL and MFP-RS Waivers

Adult Companion: MFP CL- Waiver
Chore Services: MFP CL- Waiver
Homemaker:
Individual Support and Community Habilitation: MFP CL- Waiver and MFP-RS Waiver
Peer Support: MFP CL- Waiver and MFP-RS Waiver
Waiver Personal Care: MFP CL- Waiver

Case Management in the MFP Waivers

•	All waiver participants will work with a case manager
•	As part of their person-centered planning process, each waiver participant will have a risk assessment
•	The case manager will develop a 24-hour back-up plan for each MFP Participant
•	Case manager can engage support broker for the participants as necessary

1915(b) MFP Behavioral Health Managed Care (MFP-BH) Waiver

■	Members participating in either the MFP-CL or MFP-RS waiver will be enrolled into the managed behavioral health plan through the Massachusetts Behavioral Health Partnership (MBHP)
■	Access to managed behavioral health services will help to address the significant role that behavioral health issues play in causing institutional placement and undermining community stability
■	The MFP-BH Waiver provides access to the full range of community, outpatient, and inpatient services through MBHP for all such participants.

Waiver Applications for Members 

•	Visit the MassHealth website for MFP Member Enrollment Process information and find:
•	MassHealth Waiver applications
•	MFP Brochures
•	Send completed MFP Waiver applications to: 
UMass MFP Waiver Unit
333 South Street
Shrewsbury, MA
•	For more information contact UMass Waiver Unit at 855-499-5109 or TTY 800-596-1746

Email: MFPinfo@umassmed.edu

Provider Contracting and Enrollment 

•	Mass Rehab Commission contracts with some providers, such as home/vehicle mod providers, and residential service providers
•	MRC maintains open RFRs for certain waiver services

•	Providers of many MFP waiver services enroll directly as MassHealth Providers

Provider Enrollment

■	MassHealth has engaged UMass to manage provider enrollment and credentialing activities for enrolled waiver providers.
■	Monthly Technical Assistance Sessions offer support for interested providers. UMass meets with individual providers upon request.
■	If you already enrolled as an ABI waiver provider you will only need to submit information to become qualified for additional waiver services.

For More Information About Enrolling as a Provider

Later this week, the MassHealth website will have links for the MFP Demonstration and the home and community based waivers. Both links will have information on:

■	MassHealth MFP Demonstration Assistive Technology Provider Application
•	MassHealth ABI and MFP Waiver Provider Applications and other forms
•	Links to the MassHealth Provider Regulations, MRC Provider Services Standards and Provider Rates
•	Contact information for providers about any enrollment questions or assistance with the enrollment process