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Department of Human Services “Going Home Plus”. Money Follows the Person Demonstration Grant Stakeholders Meeting Monday October 22, 2007. Section 6071 of the Deficit Reduction Act 2005. Stakeholder Meeting Objectives. Provide an overview of the grant and national trends

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Department of Human Services “Going Home Plus”

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department of human services going home plus

Department of Human Services“Going Home Plus”

Money Follows the Person Demonstration Grant

Stakeholders Meeting

Monday October 22, 2007

Section 6071 of the Deficit Reduction Act 2005

stakeholder meeting objectives
Stakeholder Meeting Objectives
  • Provide an overview of the grant and national trends
  • Provide an overview of the benchmarks
  • Provide an overview of the Guidelines for drafting the Operational Protocol
  • Discuss timelines
  • Form workgroups to draft areas of the Operational Protocol
stakeholder objectives
Stakeholder Objectives

The Objectives of the Stakeholder Committee are to:

  • Provide input as draft processes, guidelines, and criteria are developed for structuring the project
  • Provide input on policy and technical matters to the Department of Human Services

The Stakeholder Group is comprised of “community” subject matter experts and “State” subject matter experts.

medicaid spending on long term care services by type of service 2005
Medicaid Spending on Long-Term Care Services, by Type of Service, 2005



Source: AARP (2006) Across the States: Profiles of Long-Term Care and Independent Living

cms awards money follows the person
CMS Awards Money Follows The Person
  • 31 States have been awarded $1,435,709,479
    • Tier I: 17 states
    • Tier 2 13 states and D.C.
  • Since the beginning of Medicaid, this is the Single Largest Investment in Medicaid LTC (Ever)
  • Long Term Care target populations: Elders, individuals with Developmental Disabilities, Physical Disabilities, Traumatic Brain Injury and Mental Illness
  • Higherpercentage of federal matching dollars x 12 months after an individual moves out of an institution and into the community to help cover the costs of moving people out of nursing homes and into community settings
  • State Maintenance of Effort required. States must continue to provide community services after that period as long as the person needs community services and is Medicaid eligible
going home plus ghp
Going Home Plus (GHP)
  • Hawaii’s Award: $10,263,736 federal funding over 5 years
  • Dates: May 3, 2007 through September 30, 2011.
  • The Hawaii “Going Home Plus” demonstration will bring together the State’s resources to support persons who have resided in a health care institution for at least 6 months but no longer than 2 years as they transition back to community living.


1) Increase use of home and community based, rather than institutional services

Flexible Funding

2) Eliminate barriers or mechanisms (state law/budget/state plan) that prevent or restrict the flexible use of Medicaid funds


3) Increase the ability of the state Medicaid program to assure continued provision of community-based services


4) Ensure quality assurance strategies and procedures are in place

medicaid funding
Medicaid Funding
  • Federal – State partnership
  • Hawaii matching rates:

– Federal 56.5%

– State 43.5%

  • HCBS enhanced match for 12 months

– 84.75% Federal (15.25% State)

ghp funding method
GHP Funding Method
  • Performance Based Funding- The State will only being reimbursed for persons who have successfully moved into the community
  • The State is reimbursed on a per person basis

Enhanced Match for 12 months after transition

Regular Match until person no longer requires HCBS services

timeline for participants

6 months 365 days day 366 - ?

Timeline for Participants

Day of Discharge

After 365 days in demonstration, the qualified HCBS package must

continue through a waiver, managed care plan or State Plan Amendment

pre implementation phase
Pre Implementation Phase
  • 3 – 12 months planning period, must include formal stakeholder process [Hawaii- 5months]
  • Development of operational protocol
  • Identify target populations, participant selection mechanism, detailed delivery service plan, quality management system
  • Must be approved by CMS before implementation
  • Pre-implementation phase: costs for project manager, staff & transition coordinators paid at regularadministrative match
implementation phase
Implementation Phase
  • Qualified HCB Program Services
    • Enhanced Match
    • Must be continued at the conclusion of the demonstration via waivers or State Plan.
  • HCB Demonstration Services
    • Enhanced Match
    • No requirement to continue beyond the demonstration; waiver or state plan amendment would be needed.
  • Supplemental Demonstration Services
    • Regular FMAP
    • Cannot receive Federal reimbursement beyond the demonstration; short term non-waiver services; fill gaps.
  • Cannot use money for housing or bridge funds
  • Residents of Psychiatric Residential

Treatment Facilities (RTFs) not eligible

  • Group housing only where no more than 4 unrelated individuals reside
  • Cost effectiveness for waivers is required
qualified participants
Qualified Participants
  • Reside in an inpatient facility (nursing home,

ICF-MR or hospital) for a minimum of 6 months to a maximum of 2 years

  • Facility costs must have been paid by Medicaid for at least one month prior to transitioning
  • Must meet nursing facility level of care
  • Require HCBS services in order to successfully reside in a community based setting.
qualified residence
Qualified Residence
  • A home owned or leased by the individual or

family member

  • An apartment with an individual lease, with lockable

access & egress, and includes living, sleeping,

bathing and cooking areas over which the individual or family member has domain and control

  • A residence in a community based residential

setting where a maximum of 4 unrelated individuals reside.


2 Statutory Benchmarks

  • Projected #s transitioned in each target group for each demonstration year
  • Qualified Expenditures for HCBS during each of the 5 years of the program
    • Limited to state spending on HCBS (not versus institutional spending)
    • Include all Medicaid HCBS spending not just “Going Home Plus” expenditures
hawaii s proposed transitions
Hawaii’sProposed Transitions

Projection: 90% of discharges will remain in community for one year or more

more about benchmarks
More about Benchmarks
  • At least 3 additional Benchmarks[stated as measurable annual outcomes]
    • Represent the reinvestment commitment of the state
    • Are measures of progress on rebalancing the state’s system
    • Should not be related to individuals in the demo per say
  • Examples:

• Progress toward flexible financing strategies

• Increase in available supportive services

• Increases in the workforce

• Increase in self-directed services

• Increased use of transition coordinators

• Improvement in QA system

additional benchmarks
Additional Benchmarks
  • Benchmark #3:
    • Combine Medicaid State Plan and HCBS Budgets
  • Benchmark:*
    • Processes for screening, identifying and assessing transition candidates
  • Benchmark:*
    • Use of Transition Coordinators
  • Benchmark:
    • Technology to support a virtual care team
  • Benchmark:*
    • Improve quality management system for HCBS
going home plus key points
Going Home Plus Key Points
  • Oahu: Year 2 (2008) and Year 3 (2009)
  • Statewide expansion during Years 3 (2010) & 4 (2011) or earlier
  • Use of Transition Coordinators
  • One-time Transitional Costs:
  • Training Institute
  • Virtual Care Team
timeline for operational protocol
Timeline for Operational Protocol
  • Hawaii must submit its Operational Protocol to CMS no later than May, 2008.
  • CMS has 45 days from receipt of our Operational Protocol to respond.
  • The implementation phase can begin when Hawaii receives approval form CMS.
operational protocol
Operational Protocol

The objectives of the Operational Protocol are:

  • Provide CMS with an understanding of the operation of the demonstration project
  • Serve as a resource for CMS to prepare for site visits
  • Serve as a manual to State staff for demonstration project implementation
  • Provide stakeholders with an understanding of the operation of the demonstration project
operational protocol cont
Operational Protocol (cont)
  • State must submit detailed financial status reports and semi annual progress reports
  • State must participate in a national


  • State must submit Maintenance of Effort

statements annually

required contents of the operational protocol
Required Contents of the Operational Protocol

A. Project Introduction

    • 1. Case Study
    • 2. Benchmarks
  • B. Demonstration Policies and Procedures
    • 1. Participant Recruitment and Enrollment
    • 2. Informed Consent and Guardianship
    • 3. Outreach/Marketing/Education
    • 4. Stakeholder Involvement
    • 5. Benefits and Services
    • 6. Consumer Supports
    • 7. Self-Direction
    • 8. Quality
    • 9. Housing
    • 10. Continuity of Care Post Demonstration
  • C. Organization and Administration
  • D. Evaluation
  • E. Final Budget
work groups
Work groups
  • Workgroup #1: Participant Recruitment and Enrollment
  • Workgroup #2: Informed Consent and Guardianship
  • Workgroup #3: Outreach/Marketing/Education
  • Workgroup #4: Benefits & Services/Consumer Supports
  • Workgroup #5: Housing
workgroup cont
Workgroup cont.

Workgroup Composition:

  • Consumers
  • Providers, and
  • State Staff

Workgroup members shall have subject matter expertise

workgroup 1
Workgroup #1

Recruitment and Enrollment Workgroup

  • Participant selection criteria and policies
  • Development of recruitment and enrollment materials
  • Training for participants
  • Transition Coordinators
workgroup 2
Workgroup #2

Consent and Guardianship

  • Informed Consent for enrollment
  • Forms
  • Procedures for involving guardians
  • Guardianship issues and policies
workgroup 3
Workgroup #3


  • Information for enrollees, providers and case workers
  • Distribution of materials
  • Staff Training/public training
  • Media
  • Translation of materials
workgroup 4
Workgroup #4

Benefits & Services/Consumer Supports

  • Identification of services for each population
  • Service delivery system for each population
    • HCBS demonstration Services
    • Supplemental Services
  • 24hr back up system
  • Complaint/resolution process for backup & support services
workgroup 5
Workgroup #5


  • Identify types of qualified of residences available in state
  • Existing or planned inventories and shortages
  • How Medicaid will work with Housing Finance, Public Housing Authorities
  • Strategies to promote availability, affordability accessibility
upcoming meetings
Upcoming Meetings

Meeting dates:

  • Stakeholder group: 2 meetings
    • Monday, January 7, 2008
    • Monday, March 3, 2008
  • Workgroups: 4 meetings per workgroup
    • To be scheduled