Link Between the Level of Care Needs and Spending on Home- and Community-Based Services for Money Follows the Person Participants

Background: The Money Follows the Person (MFP) program assists states in transitioning individuals from long-term care facilities back to the community, where MFP participants' needs for long terms services and supports (LTSS) are addressed with home- and community-based services (HCBS). We study how MFP participants' institutional care needs are related to their HCBS expenditures.

Methods: We linked three data sources for MFP participants who transitioned from a nursing home by the end of 2009: HCBS claims, Minimum Data Set 2.0 (MDS) assessments, and MFP enrollment records. We analyzed pre-transition care needs using two measures: the ADL Summary Score and the cognitive performance scale (CPS). We adjusted HCBS expenditures by time enrolled in MFP. Two independent generalized linear models were fit to test for an association between level of care needs and HCBS expenditures.

Results: Of 5,484 individuals from 27 states who transitioned by the end of 2009 and had HCBS records, we linked 2,627 (48%) from 18 states to an MDS assessment. Using the ADL Summary measure, greater functional dependency was associated with greater HCBS spending (p<0.001), with a two-fold difference in expenditures between the lowest and highest groups. There was no linear relationship between the CPS and HCBS spending (p=0.094), but those with severe cognitive impairment had significantly higher costs than those who were not cognitively impaired (p=0.017).

Conclusion: MFP participants' HCBS expenditures were more strongly associated with functional dependencies than cognitive impairment, but severe cognitive impairment strongly predicts HCBS expenditures.