Nursing Facility Transition (NFT) initiatives are designed to provide nursing facility residents with the opportunity to leave the nursing facility and live in another setting. Transitioninitiatives are targeted to nursing home residents that have been in the facility for six months or longer and who express a desire to live in the community. Such initiatives include: individual assessments to determine the individual’s ability to live in the community; one-on-one case management; funding for one-time transition costs (e.g., security deposits); and person-centered planning to ensure that service needs are met in the community.

While most people want to live at home for as long as possible, historically long-term care public policy has been biased toward the development and utilization of institutional settings for persons needing care. However, since the 1980’s when the first Medicaid Waivers were approved, states have been working to expand home and community options for seniors and persons with disabilities. The Americans with Disabilities Act and the Olmstead Decision led to the development of both state and federal initiatives to “rebalance” long-term care focused on increasing the supply of home and community based services. Though the primary focus has been on nursing home diversion and development of home and community based services systems as an alternative to nursing home placement, states have also worked to transition residents from nursing facilities back to community settings.

From 1998 to 2000, the Centers for Medicare and Medicaid Services (CMS), in association with the federal Health and Human Services’ Assistant Secretary for Planning and Evaluation, awarded Nursing Home Transition Demonstration grants to 12 states (Arkansas, Colorado, Florida, Michigan, Nebraska, New Hampshire, New Jersey, Pennsylvania, Rhode Island, Texas, Vermont, Wisconsin). With the ability to use grant funds in creative ways with few restrictions, these states succeeded in removing administrative barriers and developing needed community supports for successful so nursing facility transitions. ¹

The New Freedom Initiative, launched by CMS in 2001, is designed to promote the removal of barriers to community living for people of all ages with disabilities and chronic illnesses. To support states’ efforts to design and implement lasting improvements in the home and community based services support system, CMS has awarded “Real Choice Systems Change Grants (RCSC) for Community Living” to all 50 states, the District of Columbia and two territories. Included among the RCSC initiatives are grants to support nursing facility transition. These grants built on the successes of the NFT Demonstration grants. BetweenOctober 1, 2002 and September 30, 2004, 33 NFT projects supported by RCSC grants were successful in transitioning 3,633 persons from nursing facilities back to their homes and communities. Thirty per cent (30%) of the individuals transitioned to the community under these grants were between 65 and 84 years of age; an additional 9% were age 85 and older.²

In addition to the RCSC/NFT grants, a number of states, including Colorado, New Jersey, Texas, Washington and Wisconsin, have developed state-specific nursing facility transition initiatives. Texas, which first enacted “Money Follows the Person” legislation in 2001, has established one of the most successful nursing facility transition initiatives. Two thousand 2000 persons were transitioned from nursing facilities in Texas back to the community between September 1, 2001 and August 31, 2003. Since September 2003, an additional 10,711 persons have been transitioned. Sixty-two percent (6,640 individuals) of those who returned to the community were 65 and older. Of these 6,640 persons: 19% were between the ages of 65 and 74; 7.5% were over 90; and 10 persons were over 100 years old.³

Finally, the Money Follows the Person (MFP) Demonstration Grants included in the Deficit Reduction Act (DRA) of 2006, will provide a new opportunity for states to work on nursing facility transition. Up to $1.75 billion over five years will be available to support states’ efforts to rebalance their long-term care systems. Funding will be targeted to residents in nursing homes for six months or longer to move back to the community. MFP funds can be used to help pay for rent deposits and other expenses such as home modification, personal assistance devices and respite for informal caregivers to enable residents to return to the community. On January 12, 2007 CMS awarded the first round of grants to 17 states.⁴

¹CMS, Center for Medicaid and State Operations, letter to State Medicaid Directors (August 13, 2002).

²Jennifer Gillespie, Nursing Facility Transition Grantee Annual Report Data: Issue Brief, Community Living Exchange (June 2005), p. 2.

³Barabara A. Ormond, Anna S. Sommers, Kristen J. Black, Examination of Texas Rider 37: A Medicaid “Money Follows the Person” Long-Term Care Initiative, The Urban Institute (May 2006).

⁴States awarded MFP Demonstration Grants by CMS: Arkansas, California, Connecticut, Indiana, Iowa, Maryland, Michigan, Missouri, Nebraska, New Hampshire, New York, Ohio, Oklahoma, South Carolina, Texas, Washington, Wisconsin.

Ombudsman Program Involvement in Nursing Facility Transition Initiatives
Money Follows the Person - The Texas Experience
Money Follows the Person - The Texas Experience (PowerPoint)
Resources on Nursing Facility Transition
PowerPoint Presentations
2007 Money Follows the Person Grant Awardees
Relocation Materials