Funding deadlines are nearing for two initiatives that encourage Medicaid beneficiaries to use long-term home and community care, according to two Kaiser Family Foundation reports. 

The short-term funding extension for Medicaid’s Money Follows the Person (MFP) program and the spousal impoverishment provision under the Affordable Care Act are both set to expire Dec. 31.

States receive enhanced federal matching funds to help seniors and people with disabilities move from institutions to the community through the MFP program, one report explained

The program has also affected nursing home occupancy rates, the authors noted. Previous research found that the “states with robust MFP programs” have seen declines in nursing home occupancy rates and reductions in the number of nursing home residents who never expect to return to the community when compared with states without a MFP program. 

“MFP seeks to reduce the Medicaid program’s institutional bias, which exists because nursing facility services must be covered, while most home and community-based services (HCBS) are provided at state option,” the authors wrote. 

“The program is credited with helping many states establish formal institution to community transition programs that did not previously exist by enabling them to develop the necessary service and provider infrastructure,” they added. 

More than 90,000 institutional residents have transitioned back into the community through the program between 2007 and June 2018. The authors warned that if Congress doesn’t reauthorize MFP, “it could hinder state efforts to help beneficiaries move from institutions to the community.” 

A separate KFF report outlined the implications of the expiration of Medicaid’s long-term care spousal impoverishment rule for community integration. 

The rule protects a portion of a married couple’s income and assets to provide for the community spouse’s living expenses when determining their nursing home financial eligibility, the report explained. A provision under the Affordable Care Act, which is set to expire, mandates that home- and community-based care and institutional care be treated equally under the rule. 

Researchers argued that reauthorizing the rules would provide “stability for enrollees and states.” 

“Applying more stringent Medicaid financial eligibility rules to HCBS than to nursing homes could slow or begin to reverse states’ progress in expanding access to HCBS, while reauthorizing the rules would provide stability for enrollees and states,” the authors wrote.