Savage is one of 1,336 disabled or elderly low-income Marylanders who as of early July had moved out of nursing homes and other institutional settings as part of a national program called Money Follows the Person. The goal is to return them to the community.
Maryland’s program is doing well compared with efforts in most of the 43 participating states and the District, having already moved 55 percent of its original target of 2,413. But the same is not true for the District and Virginia, where there are fewer stories like Sonia Savage’s. As of July 2, only 126 people had moved in the District, just 11 percent of its original five-year goal of 1,110. In Virginia, where the latest figures are from May, 362 people had moved, 35 percent of the original goal of 1,041.
Many states have fallen far short of early, optimistic projections. Five years into the program, about 22,500 people nationwide have left institutional settings and transitioned back into community settings. The states’ goal had been 35,380, a target that federal officials now say was unrealistic.
Officials at the Centers for Medicare & Medicaid Services, which administers the program, concede that it got off to a slow start. They say that many states had to create community- and home-based care systems from scratch. Some ran up against a shortage of home health workers, which many participants need. Some did not anticipate the bureaucratic challenges, such as negotiating contracts with local nonprofits to help with transitions.
Congress has authorized $4 billion for the program through September 2016. To date, the federal government has paid or committed to pay $1 billion to the states, most of which set up their programs by the end of 2008. Maryland was awarded up to $67.1 million for the first five years; Virginia, $28.6 million; and the District, $26.3 million. None has received all the allotted money, as there have been fewer participants than expected.
Money Follows the Person covers the elderly, adults with physical disabilities, the developmentally disabled and the mentally ill. Participants must choose to return to the community and be enrolled in Medicaid, the state-federal program for the poor and disabled. Transition coordinators assist them with moving into apartments, houses, small group homes or, in some cases, assisted living facilities.
The federal government gives states additional Medicaid money to help with each person’s transition over the first 12 months. This includes paying for home- and community-based services, security deposits and renovations to make housing handicap-accessible.