Money Follows the Person is a federally funded national demonstration program that seeks to help people receiving Medicaid transition from institutions, such as nursing facilities, to home and community-based services. In addition to offering more independence and a potentially better quality of life for people receiving Medicaid benefits, the program shifts spending from costlier institutional care to potentially less expensive home and community-based services.
Behavioral Health Pilot
Since 2001, when Texas first pioneered Money Follows the Person as a state initiative, thousands of Texans have returned to the community. However, people with serious mental illness and substance-use disorders experienced additional barriers to relocation.
From 2008 to 2017, Texas operated a Behavioral Health Pilot that integrated mental health and substance abuse services with home and community-based services. The pilot targeted adults who had lived in nursing facilities for at least three months, met nursing facility medical criteria and had mental illness or substance use disorders, or both.
The Behavioral Health Pilot ended on Dec. 31, 2017. Texas is currently working to sustain and spread successful practices from it, such as Cognitive Adaption Training, throughout its statewide Medicaid-managed care system. HHSC is providing training and technical assistance to State of Texas Access Reform plus Managed Care Organizations and their network providers through a contract with the International Center of Excellence for Evidence-Based Practices at University of Texas Health San Antonio. For more information on the center of excellence, visit the International Center of Excellence for Evidence Based Practices.
Behavioral Health Pilot Background
The pilot began in Bexar County (San Antonio) and expanded to adjacent counties and to Travis County (Austin). Some behavioral health services offered included Cognitive Adaptation Training and substance abuse services, which helps empower people to take charge of their lives and reach their full potential. Cognitive Adaptive Training is a rehabilitative service that provides assistance and environmental modifications to help people establish daily routines, organize their home, and hone their community living skills. Pilot substance-abuse services included individual counseling, group therapy, connection to other community programs and peer support. Cognitive Adaptive Training and substance-abuse services were available to participants for up to six months before nursing facility discharge and up to one year after relocation to the community. Home and community-based services were provided through a Medicaid-managed care program, known as State of Texas Access Reform plus Managed Care Organizations, while participants were enrolled in the pilot and after pilot services ended.
Pilot participants improved their ability to function and sustained those improvements. Over 70 percent of those who left nursing facilities under the pilot successfully maintained independence in the community. Examples of increased independence include getting a job at competitive wages, driving to work, volunteering, getting a General Equivalency Diploma, teaching art classes, leading substance-use peer support groups and working toward a college degree.
Additionally, the cost of living in the community under Money Follows the Person was significantly less than the cost of living in a nursing facility.
- National Academy of State Health Policy Conference: Sustaining Success in the Texas Behavioral Health Pilot – Portland, Oregon, 2017 (PDF)
- National Association of Medicaid Directors Conference: How Integration Supports Adopting Evidence-based Practices, November 2017 (PowerPoint)
- National Home and Community-Based Services Conference: Innovation in the Texas Behavioral Health Pilot - Washington, D.C., 2016 (PDF)
- Cognitive Adaptation Training - This manual is designed to guide health care workers in supporting people in recovery using Cognitive Adaptation Training strategies.
- Money Follows the Person Supported Employment Manual (PDF) – This manual introduces guidelines for supported employment, an evidenced-based practice to help people with mental health disorders get jobs with competitive wages based on their field of interest.
Texas strives to equip professionals with needed resources and knowledge to implement Cognitive Adaptation Training in their practice with people experiencing severe mental illness who are relocating from a nursing facility to community living. Online and in-person workshops are available via the International Center of Excellence for Evidence-Based Practices.
To learn more on the Behavioral Health Pilot, email Jessie Aric, Money Follows the Person Behavioral Health Pilot program manager.