Money Follows the Person Rebalancing Demonstration
The Money Follows the Person (MFP) Rebalancing Demonstration, authorized by section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), was designed to assist States to balance their long-term care systems and help Medicaid enrollees transition from institutions to the community. Congress initially authorized up to $1.75 billion in Federal funds through Fiscal Year (FFY) 2011. With the subsequent passage of the Patient Protection and Affordable Care Act (P.L. 111-148) in 2010, Section 2403 extended the program through September 30, 2016. An additional $2.25 billion in Federal funds was appropriated through FFY 2016. Since then, Section 2 of the Medicaid Extenders Act of 2019 (P.L. 116-3) added $112 million in Federal funds and changed the end date for the program from September 30, 2016 to September 30, 2021. Section 5 of the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116-16) changed the additional funding appropriated through the Medicaid Extenders Act from $112 million to $132 million and Section 4 of the Sustaining Excellence in Medicaid Act of 2019 (P.L 116-39) changed the additional funding appropriated through the Medicaid Services Investment and Accountability Act from $132 million to $254.5 million. Any funds remaining at the end of each fiscal year carry over to the next fiscal year, and can be used to make grant awards to current grantees through FY 2021. Any unused grant funds in 2021 can be used until 2025. No additional funding will be available after the final 2021 awards are made; however, grantees will submit documentation to identify projected costs and justify expenditures on an annual basis. Grantees can request to continue transitioning MFP participants until December 31, 2023 with services being provided and eligible for enhanced match through December 31, 2024. All claiming of services must be finalized by September 30, 2025. The MFP Demonstration supports State efforts to rebalance their long-term support system so that individuals have a choice of where they live and receive services. MFP program goals are (1) increase the use of home and community-based services (HCBS) and reduce the use of institutionally-based services; (2) eliminate barriers in State law, State Medicaid plans, and State budgets that restrict the use of Medicaid funds to let people get long-term care in the settings of their choice (3) strengthen the ability of Medicaid programs to provide HCBS to people who choose to transition out of institutions, and (4) put procedures in place to provide quality assurance and improvement of HCBS. The demonstration provides for enhanced Federal Medical Assistance Percentage (FMAP) for 12 months for qualified home and community-based services for each person transitioned from an institution to the community during the demonstration period. Eligibility for transition is dependent upon residence in a qualified institution for more than 90 consecutive days. However, days that an individual was residing in the institution for the sole purpose of receiving short-term rehabilitation services that are reimbursed under Medicare are excluded and will not be counted toward the 90-day requirement. The State must continue to provide community-based services after the 12-month period for as long as the person needs community services and is Medicaid eligible. Under the demonstration, the State must propose a system of Medicaid home and community-based care that will be sustained after the demonstration period and is deemed qualified by the Secretary. Specifically, the program must be conducted in conjunction with a "qualified HCBS program" which is a program that is in operation (or approved) in the State for such individuals in a manner that assures continuity of Medicaid coverage of services in the qualified HCBS program for eligible individuals. States may also propose to enhance the services they will provide during the demonstration period to achieve greater success with transition. States will be required to participate in a national qualitative and quantitative evaluation conducted by CMS. Data collected on a national level will help evaluate the core objectives of the statute.
General information about this opportunity
Last Known Status
Centers For Medicare and Medicaid Services, Department of Health and Human Services
Type(s) of Assistance Offered
A - Formula Grants; B - Project Grants
Section 6071, Deficit Reduction Act of 2005, Public Law 109-171; Section 2403, Affordable Care Act, Public Law 111-148, Section 2, Medicaid Extenders Act of 2019, Public Law 116-3; Section 5, Medicaid Services Investment and Accountability Act of 2019, Public Law 116-16; Section 4, Sustaining Excellence in Medicaid Act of 2019, Public Law 116-39
Who is eligible to apply/benefit from this assistance?
Applicants for this Demonstration Grant must be any single State Medicaid Agency, State Mental Health Agency, or instrumentality of the State. Only one application can be submitted for a given State. By "State" we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments." By "territory or possession", we mean Guam, the U. S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands.
As defined in Section 6071(b)(2) of the DRA and amended by Section 2403 of the Affordable Care Act, the term "eligible individual" means an individual in the State who, immediately before beginning participation in the MFP demonstration project: (i) resides (and has resided, for a period of not less than 90 consecutive days in an inpatient facility; (ii) is receiving Medicaid benefits for inpatient services furnished by such inpatient facility; and (iii) with respect to whom a determination has been made that, but for the provision of home and community-based long- term care services, the individual would continue to require the level of care provided in an inpatient facility and, in any case in which the State applies a more stringent level of care standard as a result of implementing the State plan option permitted under section 1915 (i) of the Social Security Act, the individual must continue to require at least the level of care which had resulted in admission to the institution.
Applications can only be submitted by the single State Medicaid agency. A cover letter must accompany the application. The cover letter must be signed by the State Medicaid Director, and must indicate the title of the project, the principal contact person, the amount of funding requested, and the names of the major partners actively collaborating in the project.
What is the process for applying and being award this assistance?
Preapplication coordination is required. Preapplication coordination is required. Environmental impact information is not required for this program. This program is excluded from coverage under E.O. 12372.
2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards applies to this program. This program is excluded from coverage under 2 CFR 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards.
An independent review of all applications will be conducted by a panel of experts including members of the disability community, advocates, providers and staff from State and Federal agencies including CMS. The review panel will assess each application to determine the merits of the proposal and the extent to which it furthers the purposes of the demonstration program. The panel will evaluate each application for further review by CMS. CMS reserves the right to request that States revise or otherwise modify certain sections of their proposals based on the recommendations of the panel and the budget. A low score in one or two areas, even if offset by high scores in other areas, may result in a rejection of the proposal. Final approval of demonstration projects will be made by the Administrator of CMS after consideration of the comments and recommendations of the review panelists, program office recommendations, and the availability of funds. CMS reserves the right to approve or deny any or all proposals for funding. CMS seeks to achieve reasonable balance among the grants to be awarded in a particular category in terms of key factors such as geographic distribution and broad target group representation. CMS may redistribute grant funds (as detailed in the "Award Information" section of this solicitation) based upon the number and quality of applications received. (e.g., to adjust the minimum or maximum awards permitted or adjust the aggregate amount of Federal funds allotted to a particular category of grants).
November 1, 2009 January 7, 2011 The deadline for applications was January 7, 2011, (11:59pm Eastern Standard Time).
Approval/Disapproval Decision Time
Successful applicants will receive a Financial Assistance Award (FAA) signed and dated by the CMS Grants Management Officer. The FAA is the document authorizing the grant award and will be sent through the U.S. Postal Service to the applicant organization as listed on its SF 424. Any communication between CMS and applicants prior to issuance of the FAA is not an authorization to begin performance of a project. Unsuccessful applicants will be notified by letter, sent through the U.S. Postal Service to the applicant organization as listed on its SF 424.
Appeals are governed by the Code of Federal Regulations, Title 45--Public Welfare, Subtitle A-Department of Health and Human Services, Part 16-Procedures of the Departmental Grant Appeals Board.
Any funding allocated for the Federal match for home and community-based services provided under the demonstration for the first year of this grant that remain unspent will be carried over to the next year of the Grant.
How are proposals selected?
How may assistance be used?
Indirect Costs: The provisions of the 2 CFR 225 (formerly OMB Circular A-87) govern reimbursement of indirect costs under this solicitation. A copy of OMB Cost Principles for State, Local, and Indian Tribal Governments is available online at https://www.grants.gov/learn-grants/grant-policies/omb-uniform-guidance-2014.html
What are the requirements after being awarded this opportunity?
In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003), "Audits of States, Local Governments, and Non-Profit Organizations," nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program-specific audit conducted for that year. Nonfederal entities that expend less than $500,000 a year in Federal awards are exempt from Federal audit requirements for that year, except as noted in Circular No. A-133.
Grantees are required to follow 45 CFR 74.53: Code of Federal Regulations, Title 45--Public Welfare, Subtitle A--Department of Health and Human Services, Section--74.53 Retention and access requirements for records.
Other Assistance Considerations
Formula and Matching Requirements
Statutory formula is not applicable to this assistance listing.
Matching is voluntary. A State receiving an award under this solicitation will receive reimbursement for home and community-based services provided under the demonstration on a quarterly basis at the following Federal Medical Assistance Percentage (FMAP) rates: The FMAP rate will be adjusted to reflect the increased FMAP available to States through the American Recovery and Reinvestment Act of 2009 each quarter from October 1, 2008 and extended by passage of Education, Jobs and Medicaid Assistance Act (P.L. 111-226) of 2010 through June 30, 2011 (increased rate). The funding for the increased FMAP will be provided from Money Follows the Person grant demonstration appropriations. The enhanced FMAP provided by the DRA of 2005 (Enhanced Rate increased up to 50% of the State Match capped at 90%) will be applied to the Recovery Act increased quarterly FMAP. Service Category Match rate for a 12-month demonstration period for "Qualified HCB program" services and HCB Demonstration services are at the Increased and Enhanced Match Rate. Supplemental Demonstration services will be provided at the Increased Rate only for the Recovery Act period. Administrative costs will be reimbursed according to the requirements of CFR 42, 433.15. At the end of the Recovery Act period, the yearly-published FMAP Rate in the Federal Register will be used to determine the Enhanced Rate and the State match requirements for the prior quarters to the Recovery Act period and subsequent quarters until the end of the demonstration. This program has MOE requirements, see funding agency for further details. Total expenditures under the State Medicaid program for home and community-based long-term care services will not be less for any fiscal year during the MFP demonstration project than for the greater of such expenditures for fiscal year 2005 or any succeeding fiscal year before the first of the year of the MFP demonstration project.
This program has MOE requirements, see funding agency for further details. Additional Information: This program has MOE requirements, see funding agency for further details.
Length and Time Phasing of Assistance
The demonstration period is fifteen years. The project period is from January 1, 2007 through September 30, 2021. The budget period is from January 1, 2007 through September 30, 2021. Method of awarding / releasing assistance: lump sum. Method of awarding/releasing assistance: Lump.
Who do I contact about this opportunity?
Regional or Local Office
Jennifer Bowdoin, PhD., Director
7500 Security Boulevard
Baltimore, MD 21244 US
(Formula Grants (Apportionments)) FY 18$0.00; FY 19 est $42,000,000.00; FY 20 est $215,100,000.00; FY 17$0.00; FY 16$0.00; -
Range and Average of Financial Assistance
There is not a prescribed or predetermined maximum floor or ceiling grant award. Each State is unique in the number of individuals that will be projected for transition under the demonstration grant. In addition, the costs of individuals transitioning to community settings may vary, by targeted population. Applicants are advised to request a grant award that is sufficient in the amount needed to transition the projected individuals into community settings. CMS reserves the right to reduce the requested grant award, based on the number and size of additional grant awards given under this demonstration, as well as because of concerns contained within a State's application (i.e., concerns with the number of costs of individuals projected for transition by the individual State.
Regulations, Guidelines and Literature
To promote effective outcomes from the demonstration, the statute provides waiver authority for four provisions of title XIX of the Social Security Act, to the extent necessary to enable a State initiative to meet the requirements and accomplish the purposes of the demonstration. These provisions are: (1) Statewideness (Section 1902(a)(1) of the Social Security Act) - in order to permit implementation of a State initiative in a selected area or areas of the State; (2) Comparability (Section 1902(a)(10)(B) - in order to permit a State initiative to assist a selected category or categories of individuals enrolled in the demonstration; (3) Income and Resource Eligibility (Section 1902(a)(10)(C)(i)(III) - in order to permit a State to apply institutional eligibility rules to individuals transitioning to community-based care; and (4) Provider agreement (Section 1902(a)(27)) - in order to permit a State to implement self-direction services in a cost-effective manner for purposes of this demonstration program. By "State" we refer to the definition provided under 45 CFR 74.2 as any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments. By "territory or possession", we mean Guam, the U. S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands. CMS will reimburse States for home and community-based services provided under the demonstration on a quarterly basis at a rate equal to the State's Federal Medical Assistance Percentage (FMAP) or the State's Enhanced FMAP, as specified in the solicitation. Administrative costs will be reimbursed according to the requirements of 42 CFR 433.15. Applicants completed an electronic application package, including all required forms. Standard application forms and related instructions were available online at http://gsa.gov/forms. Standard forms are available as detailed in, Section V.A, Address to Request Application Package. The following standard forms were completed with an original signature and enclosed as part of the proposal: SF 424: Official Application for Federal Assistance (see Note below*) SF 424A: Budget Information SF 424B: Assurances - Non-Construction Programs SF LLL: Disclosure of Lobbying Activities PHS-5161-1 (7/00) and Additional Certifications. Usual Requirements that must be adhered to by law and regulation: Specific administrative and policy requirements of grantees as outlined in 45 CFR 74 and 45 CFR 92, apply to this grant opportunity. All grantees receiving awards under these grant programs must meet the requirements of: Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, The Age Discrimination Act of 1975, Hill-Burton Community Service nondiscrimination provisions, and Title II Subtitle A of the Americans with Disabilities Act of 1990.
Examples of Funded Projects