Options for long-term care: The “Money Follows the Person” Rebalancing Demonstration Program (MFP) US

This initiative is an attempt by the US Federal government to help individual States reduce their
reliance on institutional settings for patients requiring long-term care. The programme is federally
funded, and started in 2007. The aim of the demonstration programme is to develop services
for people requiring long-term care, and to expand the options for the elderly and those with
disabilities to receive care in the community. Through two sub-programmes, the initiative also
aims at removing the barriers to a desirable use of Medicaid funds – namely, helping people to
get out of residential settings and into the care setting of their choice.

One of these sub-programmes, the Transition Program, focuses on people institutionalised
in nursing homes, hospitals, intermediate care centres for those with learning difficulties and
institutions for those with mental disease. Participants have been in long-term care for at least
90 days. On the day the participants are transitioned, they receive a package of services based
on home care and community care. They can hire their own caregivers, and can purchase
support that enables them to live at home.

The other sub-programme, the Rebalancing Program, funds individual States to shift local
long-term care requirements away from institutions; for example, through financing the costs
of closing beds or facilities, expanding home- and community-based services, and providing
affordable housing.

Programme evaluation shows that there has been a steady increase in participants. Despite
some early setbacks, there is a powerful incentive to shift from a care model based on
institutions to one based on people staying in the community.