Form CMS-10249 MFP Semi-Annual Report

Administrative Requirements for Section 6071 of the Deficit Reduction Act of 2005 (CMS-10249)

MFP_Final_06SEP17 (2018_1)

Administrative Requirements for Section 6071 of the DRA (CMS-10249)

OMB: 0938-1053

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0938-1053 can be found here:

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MONEY FOLLOWS THE PERSON (MFP)
SEMI-ANNUAL PROGRESS REPORT

CMS-10249
OMB 0938-1053 (Expires: TBD)

This PDF reporting form is to be used by grantees for semi-annual reporting of MFP program data.
The information provided in this report will allow CMS to monitor grantee progress and identify
challenges and improvement opportunities. For additional guidance on completing this form, please see
the associated User Guide and Help File, available from your CMS Project Officer or at http://www.mfptac.com/.
Please save the file to your local PC using the following naming convention: State Initials_
Reporting Year_ Reporting Period (1 or 2) (for example, AL_2017_Period1). While completing the
reporting form, please save your work often by selecting File >>> Save in the upper left hand
corner of the PDF.

A. General Information
Organization Information
1. Full Name of Grantee Organization
2. Program's Public Name
3. Program's Website
Project Director
4. Project Director Name
5. Project Director Title
6. Project Director Phone
7. Project Director Fax
8. Project Director Email
9. Project Director Status (may check multiple)
Full Time

Acting

Vacant

New Since Last Report

10. Project Director Status Date: Change date if status is different from last report.
(MM/DD/YYYY)

Grantee Signatory
11. Grantee Signatory Name
12. Grantee Signatory Title
13. Grantee Signatory Phone
14. Grantee Signatory Fax
15. Grantee Signatory Email

16. Has the Grantee Signatory changed since last report?
Yes
No
Other State Contact
17. Other State Contact Name
18. Other State Contact Title
19. Other State Contact Phone
20. Other State Contact Fax
21. Other State Contact Email
Independent State Evaluator
22. Independent State Evaluator Name
23. Independent State Evaluator Title and
Organization
24. Independent State Evaluator Phone
25. Independent State Evaluator Fax
26. Independent State Evaluator Email
Report Preparer
27. Report Preparer Name
28. Report Preparer Title
29. Report Preparer Phone
30. Report Preparer Fax
31. Report Preparer Email
CMS Project Officer
32. CMS Project Officer Name

B. Transitions
Update Section B. each period. During Period 1 reporting, leave Period 2 fields blank. During Period 2
reporting, add Period 2 data below existing Period 1 data. Red outlined cells indicate a manual calculation
is required; green outlined cells indicate the PDF will auto-calculate the field.
1. Please specify your MFP program’s “Other” target population(s) here if applicable.

2. Please note the characteristics and/or diagnoses of your MFP program’s “Other” target
population(s).

3. Number of people assessed for MFP enrollment. [Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. First period (Jan 1 – June 30)

b. Second period (July 1 – Dec 31)

c. Total (period 1 + period 2)

d. Cumulative number assessed
(cumulative assessments as of last
period report (Q3, row d) + new
assessments current period report (Q3,
row c))

e. Transition targets, all grant years
(by population and total)

f. Cumulative number assessed as a
percent of total transition target (total
assessed (row d) / total transition target
(row e)

0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Please indicate what constitutes an assessment for MFP versus any other transition program.

4. Number of institutional residents who transitioned during this reporting period and enrolled in
MFP. [Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. First period (Jan 1 – June 30)

b. Second period (July 1 – Dec 31)

c. Total (period 1 (row a) + period 2
(row b))

d. Annual transition target

e. Percent of annual transition target
achieved

0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

5. Cumulative number of MFP transitions to date. The cumulative transition total is the sum of
the previous period’s cumulative transitions and the current period’s transitions. If you need
to adjust the cumulative MFP transitions to date, please enter the positive and/or negative
adjustment value in the corresponding cell of the table below. For example, if your records
show 5 fewer older adult transitions than the table shows, you should enter ‘-5’ in the
adjustment value row under "Older Adults". The PDF will calculate a revised total in the
“Adjusted Cumulative Total” row.
If applicable, please provide an explanation as to why your cumulative
transition counts need to be updated.

Older
Adults

ID/DD

Other

Total

a. Cumulative transitions

(previous period cumulative transitions
(Q5, Row c) + current period transitions
b. Adjustment value for cumulative
transitions

c. Adjusted cumulative total

d. Transition targets, all grant years

(by population and total)

6. Total number of current MFP participants. Current MFP participants excludes individuals
whose enrollment in the MFP demonstration ended because they completed their 365 days
of MFP eligibility, died before they exhausted their 365 days of eligibility, or were
institutionalized for 30 days or more and did not subsequently re-enroll in the MFP program
[Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. First period (Jan 1 – June 30)

b. Second period (July 1 – Dec 31)

7. Number of MFP participants re-institutionalized. [Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. For less than or equal to 30 days

b. For more than 30 days

c. Length of stay as yet unknown

d. Total re-institutionalized for any length of
time (total of row a + row b + row c))

e. Number of MFP participants reinstitutionalized as a percent of all current
MFP participants
(Total reinstitutionalized (Q7, row d)/ total
current (Q6))*100
f. Number of MFP participants reinstitutionalized as a percent of cumulative
transitions

0.00% 0.00% 0.00% 0.00% 0.00% 0.00%

Please indicate any factors that contributed to re-institutionalization.
[……………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………

…………………………………………………………………………………………………………]
8. Number of MFP participants re-institutionalized for longer than 30 days, who were reenrolled in the MFP program during the reporting period. [Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. First period (Jan 1 – June 30)

b. Second period (July 1 – Dec 31)

c. Total (period 1 (row a) + period 2 (row
b))

9. Number of MFP participants -who ever transitioned -who completed the 365-day transition
period during the reporting period. [Refer to Help file for explanation]
Older
Adults

ID/DD

Other

Total

a. First period (Jan 1 – June 30)

b. Second period (July 1 – Dec 31)

c. Total (Period 1 (row a) + Period 2
(row b))

Please indicate any factors that contributed to participants not completing the 365-day transition
period.
[……..
.……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………….]
10. Did your program have difficulty transitioning the projected number of persons it proposed to
transition in the Operational Protocol? If yes, please check the target populations that apply.

□Yes
(If Yes) Please select the populations affected:
□Older Adults, □ ID/DD, □ MI, □ PD, □ Other.

□No
Please describe your difficulties for each target population.

[……….
.……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………..]

11. Does your state have other nursing home transition programs that currently operate
alongside the MFP program?

□Yes
(If Yes) Please approximate the number of individuals who transitioned through other
transition programs during this reporting period.
(If Yes) Please explain how these other transition programs differ from MFP, e.g.
eligibility criteria.
[…..
.……………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………………]

□No
12. Does your state have an ICF-IDD transition program that currently operates alongside the
MFP program?

□Yes
(If Yes) Please approximate the number of individuals who transitioned through other
transition programs during this reporting period.
(If Yes) Please explain how these other transition programs differ from MFP e.g. eligibility
criteria.
[……………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………………………………]

□No
13. Do you intend to seek CMS approval to amend your annual or total Demonstration period
transition benchmarks in your approved Operational Protocol?

□Yes
(If Yes) Please explain the proposed changes to your transition benchmarks.
[………………………..
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………..]

□No

14. Tribal Initiative Only - Report the number of people enrolled, transitioned and reinstitutionalized during the report period by population served, i.e., Older Adults, ID/DD, MI,
PD, Other. Reported numbers are a subset of the total numbers reported in questions 3, 4
and 7.
Older
Adults

ID/DD

Other

Total

a. Enrolled

b. Transitioned

c. Re-institutionalized for more
than 30 days

Did the Tribal Initiative have any difficulty transitioning the projected number of individuals it
proposed in the Operational Protocol during the reporting period?
[………………..
………….…………………………………………………………………………………………………
……………………………………………………………………………………….]
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section (B).
[…………
……….……………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………………………………………………………………………]

C. Qualified HCBS Expenditures
Completed during the second reporting period (July-December) only.
1. Do you require modifying the Actual Level of Spending for last period?

□Yes
(If Yes) Please describe why the changes were necessary and update in the table
below.
[….
….…………………………………………………………………………………………………
………………………………………………………………………………………………………
……………………………………………………………………..]

□No
Qualified expenditures are total Medicaid HCBS expenditures (federal and state funds) for all Medicaid
recipients (not just MFP participants), including: expenditures for all 1915c waiver programs, home
health services, and personal care if provided as a State Plan optional service, as well as HCBS
spending on MFP participants (qualified, demonstration and supplemental services), and HCBS
capitated rate programs to the extent that HCBS spending can be separated from the total capitated
rate.
Qualified HCBS Expenditures: Actual level of spending for each Calendar Year (CY) or State Fiscal
Year (SFY) (column 4) is the sum of:
1) HCBS expenditures for all 1915c waivers and state plan HCBS services -- from CMS 64
data and
2) MFP expenditures -- from MFP Financial Reporting Forms A and B.
Grantees should enter total annual spending once each year. When making updates or corrections to
actual spending amounts reported for the previous year, please check the 'yes' box at the top of this
page to flag such changes.
Please enter data for the relevant reporting period and year. Cells outlined in red indicate a
calculation is needed.

Year

Target
Level of
Spending

% Annual
Growth
Projected

Total Spending
for the
Calendar Year

% Annual
Change
(From
Previous
Year)

% of Target
Reached

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Explain Year End
Rate of Progress

2. Do you intend to seek CMS approval to amend your annual benchmarks for Qualified HCBS
Expenditures in your approved Operational Protocol?

□Yes
(If Yes) Please explain the proposed changes to your Qualified HCBS Expenditures
benchmark.
[…………..
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………………………….]

□No
3. Please specify (CY or SFY) and the dates of your SFY here.
4. Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section (C).
[….
…………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]

D.1

Additional Benchmarks

 This section requests information and data on progress made towards achieving the state’s
additional MFP benchmarks, at least one of which reflects the state’s reinvestment of savings
generated under MFP to rebalance the state’s long-term care system. The information below
reflects your state’s additional benchmarks as described in the CMS-approved Operational
Protocol. If your state has not achieved the benchmark measure for this reporting period, please
use the text box below to explain the barriers or challenges that have hindered progress, and
plans to address them.
 Benchmarks for grantees participating in the Tribal Initiative can be added here.
 Please enter data for the relevant reporting period and year. Green outlined cells indicate the
PDF will auto-calculate the field.

Benchmark #1: [Please describe as specified in Operational Protocol]
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
………………………………………….
Measure #1 [Please describe as specified in Operational Protocol]
[………………………………………………………………………..]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
[. ………..
.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]

Measure #2 (If applicable) [Please describe as specified in Operational Protocol]
[..…………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1-June
30)

Measure
Second
Period (July
1 – Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Do you intend to seek CMS approval to amend your additional benchmarks in your approved
Operational Protocol?

□Yes

..………..
(If Yes)

.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..

□No
Benchmark #2: [Please describe as specified in Operational Protocol]
[.
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
……………………………………………………………………]
Measure #1: [Please describe as specified in Operational Protocol]
[.…………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
[[. ………..
.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]

Measure #2 (if applicable) [Please describe as specified in Operational Protocol]

[.…………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
[.. ………..
.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]
Measure #3 (if applicable) [Please describe as specified in Operational Protocol]
[..…………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
.. ………..
.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]

Benchmark #3: [Please describe as specified in Operational Protocol]
[……………
………..………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
………………………………………………………………………..]
Measure #1: [Please describe as specified in Operational Protocol]
.………………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
[… ………..
.……..……………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]
Measure #2 (if applicable) [Please describe as specified in Operational Protocol]
[……………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:
[……..
…..………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………..]
Measure #3 (if applicable) [Please describe as specified in Operational Protocol]
[…………………………………………………………………………………]

Year

Measure
Target

Measure
First Period
(Jan 1 June 30)

Measure
Second
Period (July
1 - Dec 31)

Measure
Entire
Year

% Achieved
First Period

%
Achieved
Second
Period

%
Achieved
Entire
Year

2017

0.00%

2018

0.00%

2019

0.00%

2020

0.00%

Please explain your Year End rate of progress:

D.2. Rebalancing Efforts
Completed only during the first period (January – June) of each year
 All MFP grantees are required to complete this section during the first period to report on the
cumulative amount spent to date and use of rebalancing funds. MFP "Rebalancing Funds"
refers to the net revenue each state receives from the enhanced FMAP rate (over the state's
regular FMAP) for qualified and demonstration HCBS services provided to MFP participants.
MFP grantees are required to reinvest the rebalancing funds in initiatives that will help to
rebalance the long-term care system. The rebalancing fund amount is calculated on your annual
Worksheet for Proposed Budget --- see "Rebalancing Fund Calculation" box in the middle of the
Excel Worksheet.
 Rebalancing funds being used for specific Tribal Initiatives can be added here by participating
grantees.
In the table below, enter information on expenditures and activities, whether continuing from prior
reporting periods or initiated during this current reporting period, for each rebalancing initiative. If there
are more than 6 rebalancing initiatives, please combine related programs and initiatives so that there
are no more than 6.
If you have not spent any rebalancing funds to date, enter "$0.00" in the Total Actual Expenditures box,
and in the text box, describe how your state intends to spend rebalancing funds, and indicate when the
state expects to begin spending these funds.
Rebalancing
Initiative Name

Brief Description of Initiative

Total Actual Expenditures
for this initiative (cumulative
spending from start of MFP
grant program through end
of last calendar year).

Explain any missing or
incomplete data.

5.
6.

Total

----

0.00

----

E.1. Recruitment & Enrollment
1. Did anything change during the reporting period that made recruitment easier? Choose
from the list below and describe by target population for each checked box. Check "None" if
nothing has changed.
□Type or quality of data available for identification
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ How data are used for identification
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[……..
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Obtaining provider/agency referrals or cooperation
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.

□ Obtaining self referrals
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[…………….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Obtaining family referrals
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[…..
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Assessing needs
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[……………….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ None
2. What significant challenges did your program experience in recruiting individuals? Choose
from the list below and describe by target population for each checked box. Significant
challenges are those that affect the program’s ability to transition as many people as
planned.
□ Type or quality of data available for identification
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[………………..
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[………………………..
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice

□ Obtaining provider/agency referrals or cooperation
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[…………
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[………………
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Obtaining self referrals
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[……
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[…………….
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

□ Obtaining family referrals
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[………………………
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[……………..
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[………….
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Assessing needs
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[…………….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[…………………
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[………………..
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

□ Lack of interest among people targeted or the families
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[……..
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[…
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Unwilling to consent to program requirements
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[……………..
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[…………..
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[………….
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[……….
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ None
3. Did anything change during the reporting period that made enrollment into the MFP program
easier? These changes may have been the result of changes in your state’s Medicaid
policies and procedures. Choose from the list below and describe by target population for
each checked box.
□ Determination of initial eligibility
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[…………
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]

□ Redetermination of eligibility after a suspension due to re-institutionalization
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ None

4. What significant challenges did your program experience in enrolling individuals? Significant
challenges are those that affect the program’s ability to transition as many people as
planned. Choose from the list below and describe by target population for each checked
box.
□ Determining initial eligibility
Populations Affected
Older Adults

ID/DD

Other

□

□ Reestablishing eligibility after a suspension due to re-institutionalization
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

□ None
5. Total number of MFP candidates assessed in this period, or a prior reporting period, who
are currently in the transition planning process that is "in the pipeline," and expected to
enroll in MFP.
Total
6. Total number of MFP eligible individuals assessed in this period for whom transition
planning began but were unable to transition through MFP.
Total
7. How many individuals could not be enrolled in the MFP program for each of the following
reasons:
Individual transitioned to the community, but did not enroll in MFP
Individual's physical health, mental health, or other service needs or estimated costs were
greater than what could be accommodated in the community or through the state's current
waiver programs
Individual could not find affordable, accessible housing, or chose a type of residence that
does not meet the definition of MFP qualified residences
Individual changed his/her mind about transitioning, did not cooperate in the planning
process, had unrealistic expectations, or preferred to remain in the institution
………………..
Individual's family member or guardian refused to grant permission, or would not provide
back-up support
Other, Please specify below
If necessary, please explain further why individuals could not be transitioned or enrolled in
the MFP program.
[. ……………………………………………………………………………
…………………………………………………………………………………………………………
……………………………………………………………………………………………………..]

8. Number and percent of MFP participants transitioned during this period whose length of time
from assessment to actual transition took:
Number

Percent

Less than 2 months

0.00%

2 to 6 months

0.00%

6 to 12 months

0.00%

12 to 18 months

0.00%

18 to 24 months

0.00%

24 months or more

0.00%

Please indicate the average length of time required from assessment to actual transition.
[.………………………………………………………….]
9. Total number of individuals who were referred to the MFP program through MDS 3.0 Section
Q referrals during the reporting period. Please report an unduplicated count.
Total
10. Of the MDS 3.0 Section Q referrals ever received by the MFP program, number of
individuals who subsequently enrolled in MFP and transitioned to the community during this
reporting period.
Total
11. What types of activities were supported by ADRC/MFP Supplemental Funding Opportunity
C grant funds during this reporting period, awarded to MFP grantee states to support
activities that help to expand the capacity of ADRCs as part of a no wrong door (NWD)
system to assist with MFP transition efforts, and partner in utilizing the revised Minimum
Data Set (MDS) 3.0 Section Q referrals? Choose from the list below. Check “Not Applicable”
if your State did not receive this funding.
□ Develop or improve Section Q referral tracking systems–electronic or other
□ Education and outreach to nursing facility or other LTC system staff to generate referrals to
MFP or other transition programs
□ Develop or expand options counseling or transition planning and assistance
□ Train current or new ADRC staff to do transition planning in MFP or other transition programs
□ Expansion of ADRC program in State
□ Other activities – please describe in text box
[…………..
………………………………………………………………………..……………………….]
□ Not applicable – state did not receive this grant

12. Please describe progress in implementing the activities identified in Question # 11 during
this past reporting period, and how they have helped your state achieve MFP goals. In
addition, describe the results or outcomes of these activities; if you specified numerical
targets in your grant proposal, please provide counts during the reporting period.
[..
…………………………………………………………………………………………………………
………………………………………………………………………………………………………..]
13. Please describe any barriers or challenges in implementing the identified activities and the
steps you are taking to resolve them.
[…
…………………………………………………………………………………………………………
…………………………………………………………………………………………………...]
14. Tribal Initiative Only – Changes that made recruitment and/or enrollment easier. Identify
challenges that the program had recruiting and/or enrolling individuals during this reporting
period.
[…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…]
Total number of MFP candidates under the Tribal Initiative assessed in this period, or a
prior reporting period, who are currently in the transition planning process and expected to
enroll in MFP (a subset of the total in question 5)
Total number of MFP eligible individuals under the Tribal Initiative assessed in this period
for whom transition planning began but were unable to transition through MFP (a subset of
the total in question 6)
Provide reasons why tribal members in the Tribal Initiative could not enroll in MFP and the
average length of time from assessment to actual transition. Identify any barriers or challenges
in implementing the activities proposed in your grant application and steps you are taking to
resolve them.
………………….
………………………………………………………………………………………………………………
……………………………………………………………………………………………………………]

E.2. Informed Consent & Guardianship
1. What changed during the reporting period that made obtaining informed consent easier?
Choose from the list below and describe by target population for each checked box.
□ Revised inform consent documents and/or forms
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[……………..
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Provided more or enhanced training for transition coordinators
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[….
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Improved how guardian consent is obtained
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Nothing
2. What changed during the reporting period that improved or enhanced the role of guardians?
Choose from the list below and describe by target population for each checked box.
□ The nature by which guardians are involved in transition planning
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Communication or frequency of communication with guardians
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]

□ The nature by which guardians are involved in ongoing care planning
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ The nature by which guardians are trained and mentored
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Nothing

3. What significant challenges did your program experience in obtaining informed consent?
Choose from the list below and describe by target population for each checked box.
□ Ensuring informed consent
Populations Affected
Older Adults

ID/DD

Other

□

□ Involving guardians in transition planning
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Communication or frequency of communication with guardians
Populations Affected
Older Adults

ID/DD

Other

□

□ Involving guardians in ongoing care planning
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Training and mentoring of guardians
Populations Affected
Older Adults

ID/DD

Other

□

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

E.3. Outreach, Marketing & Education
1. What notable achievements in outreach, marketing or education did your program
accomplish during the reporting period? Choose from the list below and describe by target
population for each checked box.
□ Development of print materials
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Implementation of localized/targeted media campaign
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Implementation of statewide media campaign
Populations Affected
Older Adults

ID/DD

Other

□

□ Involvement of stakeholder state agencies in outreach and marketing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Involvement of discharge staff at facilities
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Involvement of ombudsman
Populations Affected
Older Adults

ID/DD

Other

□

□ Training of frontline workers on program requirements
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

2. What significant challenges did your program experience in conducting outreach, marketing,
and education activities during the reporting period? Choose from the list below and
describe by target population for each checked box.
□ Development of print materials
Populations Affected
Older Adults

ID/DD

Other

□

□ Implementation of a localized / targeted media campaign
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Implementation of a statewide media campaign
Populations Affected
Older Adults

ID/DD

Other

□

□ Involvement of stakeholder state agencies in outreach and marketing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Involvement of discharge staff at facilities
Populations Affected
Older Adults

ID/DD

Other

□

□ Involvement of ombudsman
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Training of frontline workers on program requirements
Populations Affected
Older Adults

ID/DD

Other

□

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ None
3. Tribal Initiative Only – Describe any outreach, marketing and education activities and
challenges during this reporting period specific to the Tribal Initiative.
[.
………………………………………………………………………………………………………………
……………………………………………………………………………………………………………..]

E.4. Stakeholder Involvement
1. How are consumers and families involved in MFP during this period and how did their
efforts contribute to MFP goals and benchmarks, or inform MFP and LTC policies? Check
all that apply.
Provided
Input on MFP
Policies or
Procedures

Helped to
Promote or
Market MFP
Program

Involved in
Housing
Development

Involved in
Quality of
Care
Assurance

Attended
MFP
Advisory
Meeting(s)

Consumers

□

Families

□

Advocacy
Organizations

□

HCBS Providers

□

Institutional
Providers

□

Labor/Worker
Association(s)

□

Public Housing
Agency(ies)

□

Other State
Agencies (except
Housing)

□

Non-profit Housing
Assn.

□

Other

Other (describe)

Please explain the nature of consumers’ and families’ involvement in MFP during this period and how it
contributed to MFP goals and benchmarks, or informed MFP and LTC policies
[.
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………….]
Please explain the nature of others’ (non-consumers) involvement in MFP during this period and how it
contributed to MFP goals and benchmarks, or informed MFP and LTC policies
[.
………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………
……………………………………………………………………………………………………………………..]

2. On average, how many consumers, families, and consumer advocates attended each
meeting of the MFP program's advisory group (the group that advises the MFP program)
during the reporting period?
□ Specific Amount
Please Indicate the Amount of Attendance
[.…………………………………………………………..]
□ Advisory group did not meet during the reporting period
□ Program does not have an advisory group
3. What types of challenges has your program experienced involving consumers and families
in program planning and ongoing program administration? Choose from the list below and
describe by target population for each checked box.
□ Identifying willing consumers
What are you doing to address the challenges?
[..………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ Identifying willing families
What are you doing to address the challenges?
[.………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ Involving them in a meaningful way
What are you doing to address the challenges?
[.………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ Keeping them involved for extended periods of time
What are you doing to address the challenges?

[.………………………………………………………………………………………………………
………………………………………………………………………………………..]

□ Communicating with consumers
What are you doing to address the challenges?
[.………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ Communicating with families
What are you doing to address the challenges?
[.………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ Other, specify below
What are you doing to address the challenges?
[.………………………………………………………………………………………………………
………………………………………………………………………………………..]
□ None

4. Did your program make any progress during the reporting period in building a collaborative
relationship with any of the following housing agencies or organizations? If yes, please
describe.
□ State agency that sets housing policies
Please describe
[.
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]
□ State housing finance agency
Please describe
[.
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]

□ Public housing agency(ies)

Please describe
[.
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]
□ Non-profit agencies involved in housing issues
Please describe
[.
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]
□ Other housing organizations (such as landlords, realtors, lenders and mortgage brokers)
Please describe
[.
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………
………………………………………………………………………………………………………………]
□ None

5. Has your program experienced significant challenges in building a collaborative relationship
with any of the agencies involved in setting state housing policies, financing, or
implementation of housing programs?
□Yes
(If Yes) Please Describe
[……….
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
………………………………………………………………………………………………]
□ No
6. Tribal Initiative Only - Describe the nature of the stakeholder efforts within the tribal
initiative during this reporting period that include the role of the MFP advisory group in
relationship to the initiative; any new advisory groups or efforts specific to this initiative;
number of tribal members that are actively involved in an advisory capacity and any
challenges that face stakeholder involvement in the initiative.
[.…
………………………………………………………………………………………………………
……………………………………………………………………………………………………]

E.5. Benefits & Services
1. What progress was made during the reporting period regarding Medicaid programmatic and
policy issues that increased the availability of home and community-based services
DURING the one-year transition period? Choose from the list below and describe by target
population for each checked box.
□ Increased capacity of HCBS waiver programs to serve MFP participants
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Added a self-direction option
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Developed State Plan Amendment to add or modify benefits needed to serve MFP

participants in HCBS settings
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.

□ Developed or expanded managed LTC programs to serve MFP participants
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Obtained authority to transfer Medicaid funds from institutional to HCBS line items to
serve MFP participants
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Legislative or executive authority for more funds or slots or both
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.

□ Improved state funding for pre-transition services (such as targeted case management)
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

2. What significant challenges or barriers did your program experience in guaranteeing that
MFP participants can be served in Medicaid HCBS DURING the one-year transition period?
Choose from the list below and describe by target population for each checked box.
□ Efforts to increase capacity of HCBS waiver programs to serve more individuals are delayed
or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Efforts to add a self-direction option are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ State Plan Amendment to add or modify benefits needed to serve people in HCBS settings
are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Plans to develop or expand managed LTC programs to serve or include people needing
HCBS are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Efforts to obtain authority to transfer Medicaid funds from institutional to HCBS line items to
serve people transitioning out of MFP are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Legislative or executive authority for more funds or slots are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ State funding for pre-transition services (such as targeted case management) have been
delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

3. What progress was made during the reporting period on Medicaid programmatic and policy
issues to assure continuity of home and community based services AFTER the one-year
transition period? Choose from the list below and describe by target population for each
checked box.
□ Increased capacity of HCBS waiver programs to serve more Medicaid enrollees
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

participants in HCBS settings
Populations Affected
Older Adults

ID/DD

Other

□

□ Developed or expanded managed LTC programs to serve more Medicaid enrollees
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Obtained authority to transfer Medicaid funds from institutional to HCBS line items to serve
more Medicaid enrollees
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

Please describe by target population.

□ Improved state funding for pre-transition services, such as targeted case management
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

4. What significant challenges or barriers did your program experience in guaranteeing
continuity of care for MFP participants in Medicaid HCBS AFTER the one-year transition
period? Choose from the list below and describe by target population for each checked box.
□ Efforts to increase capacity of HCBS waiver programs to serve more individuals are delayed
or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Efforts to add a self-direction option are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ State Plan Amendment to add or modify benefits needed to serve people in HCBS
settings is delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Plans to develop or expand managed LTC programs to serve or include people needing
HCBS are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ Efforts to obtain authority to transfer Medicaid funds from institutional to HCBS line items
to serve people transitioning out of MFP are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Legislative or executive authority for more funds or slots are delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

□ State funding for pre-transition services have been delayed or disapproved
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

□ None
5. Tribal Initiative Only - What progress was made during the period toward addressing any
programmatic and/or policy issues as well as any specific challenges that might affect the
availability of home and community-based services during and after the one-year transition
period. Please describe the efforts by populations affected.
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
……………………………………………………………]

E.6. Participant Access to Services
1. What steps did your program or state take during the reporting period to improve or
enhance the ability of MFP participants to access home and community based services?
Choose from the list below and describe by target population for each checked box.
□ Increased the number of transition coordinators
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased the number of home and community-based service providers contracting
with Medicaid
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased access requirements for managed care LTC providers
Populations Affected
Older Adults

ID/DD

Other

□

□ Increased payment rates to HCBS providers
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased the supply of direct service workers
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Improve or increased transportation options
Populations Affected
Older Adults

ID/DD

Other

□

□ Added or expanded managed LTC programs or options
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

2. What are MFP participants' most significant challenges to accessing home and communitybased services? These are challenges that either make it difficult to transition as many
people as you had planned or make it difficult for MFP participants to remain living in the
community. Choose from the list below and describe by target population for each checked
box.
□ Insufficient supply of HCBS providers
Populations Affected
Older Adults

ID/DD

Other

□

□ Insufficient supply of direct service workers
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Preauthorization requirements
Populations Affected
Older Adults

ID/DD

Other

□

□ Limits on amount, scope, or duration of HCBS allowed under Medicaid state plan or
waiver program
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Lack of appropriate transportation options or unreliable transportation options
Populations Affected
Older Adults

ID/DD

Other

□

□ Insufficient availability of home and community-based services (provider capacity does not
meet demand)
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

3. Tribal
Initiative Only - What steps did your program take to improve access to home and
community-based service during this reporting period? What challenges exist to accessing
services and what efforts are underway to address these challenges under the tribal
initiative? (see questions 1 and 2 for examples of some activities and challenges)

E.7. Self-Direction
Did your state have any self-direction programs in effect during this reporting period?

□Yes
□No
1. If YES, how many MFP participants were in a self-direction program as of the last day of
the reporting period?
Older Adults

ID/DD

Other

Total

2. Of those MFP participants in a self-direction program how many:

Older
Adults

ID/DD

Other

Total

Hired or supervised their own
personal assistants
Managed their allowance or budget

3. How many MFP participants in a self-direction program during the reporting period reported
abuse or experienced an accident?
Older
Adults

ID/DD

Other

Total

Reported being abused by an
assistant, job coach, or day
program staff
Experienced an accident (such as
a fall, burn, medication error
Other, Please specify
.]

4. How many MFP participants in a self-direction program disenrolled from the self-direction
program during the reporting period?
Older Adults

ID/DD

Other

Total

5. Of the MFP participants who were disenrolled from a self-direction program, how many were
disenrolled for each reason below?
Older
Adults

ID/DD

Other

Total

Opted-out
Inappropriate spending
Unable to self-direct
Abused their worker
Other, Please specify

6. Tribal
Initiative Only - As a subset of the numbers reported in questions 1-5, provide the

number of tribal members by population that directed their own service, reported abuse or
experienced an accident, dis-enrolled in self-directed services during the reporting period.
Older
Adults

ID/DD

Other

Total

Directed their own service
Reported abuse or experienced an
accident
Dis-enrolled in self-directed services

Please describe your efforts within the tribal initiative to offer self-directed services.
[………………..
…………………………………………………………………………………………………
…………………………………………………………………………………………………..]
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section (E.7).
[. …………………………………………………………………………………………………
…………………………………………………………………………………………………..]

E. 8. Quality Management & Improvement
✔ Do you want the information on critical incidents in questions #6 through #10 on this page to appear
□
in print version of the report? If not, please uncheck box.

1. What notable improvements did your program make to your HCBS quality management
systems that affect MFP participants? These improvements may include improvements to
quality management systems for your state’s waiver programs.
□ Improved intra/inter departmental coordination
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Implemented/Enhanced data collection instruments
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Implemented/Enhanced information technology applications
Populations Affected
Older Adults

ID/DD

Other

□

□ Implemented/Enhanced consumer complaint processes
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Implemented/Enhanced quality monitoring protocols DURING the one-year transition
period (that is, methods to track quality-related outcomes using identified benchmarks or
identifying participants at risk of poor outcomes and triggering further review at a later
point in time)
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Enhanced a critical incident reporting and tracking system. A critical incident (e.g., abuse,
neglect and exploitation) is an event that could bring harm, or create potential harm, to a
waiver participant.
Populations Affected
Older Adults

ID/DD

Other

□

□ Enhanced a risk management process
Populations Affected
Older Adults

ID/DD

Other

□

ID/DD

Other

□

2. How many calls did your program receive from MFP participants for emergency back-up
assistance during the reporting period by type of assistance needed? Emergency refers to
situations that could endanger the health or well-being of a participant and may lead to a
critical incident if not addressed. (Please note this question only captures calls that were
considered to be emergencies and not those that are informational or complaints.)
Older
Adults

ID/DD

Other

Total

Transportation to get to medical
appointments

Life-support equipment
repair/replacement

Critical health services

Direct service/support workers not
showing up

Other, Please Specify [.
………….]

Total

3. For what number of the calls received were you able to provide the assistance that was
needed when it was needed?
Older Adults

ID/DD

Other

Total

4. Did your program have to change back-up services or quality management systems due to
an identified problem or challenge in the operation of your back-up systems?

□Yes
(If Yes) Please Describe
[………………..
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………]

□No
5. Did your program experience any challenges in:
□ Developing adequate and appropriate service plans for participants, i.e., developing service
plans that address the participant’s assessed needs and personal goals
Populations Affected
Older Adults

ID/DD

Other

□

□ Assessing participants’ risk
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Developing, implementing, or adjusting risk mitigation strategies
Populations Affected
Older Adults

ID/DD

Other

□

□ Addressing emergent risks in a timely fashion
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Delivering all the services and supports specified in the service plan
Populations Affected
Older Adults

ID/DD

Other

□

□ Modifying the service plan to accommodate participants’ changing needs or circumstances,
i.e., increasing units of a service, adding a different type of service, changing time of day
when services are delivered, etc.
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Identifying threats to participants’ health or welfare
Populations Affected
Older Adults

ID/DD

Other

□

□ Addressing threats to participants’ health or welfare
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

6. Please specify the total number of participant deaths that occurred during the reporting
period:
Older Adults

ID/DD

Other

Total

7. Please provide information on the circumstances surrounding the reported deaths:
[.
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………..]
8. How many critical incidents occurred during the reporting period? [.
9. Please provide information on the circumstances surrounding the reported critical incidents:
[.
……………………………………………………………………………………………………………
……………………………………………………………………………..]
10. Please describe the nature of each critical incident that occurred. Choose from the list
below.
□ Abuse
Please specify the number of times this type of critical incident occurred.
.
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
..
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[..……………………………………………………………………………………………
………………………………………………………………………………….]

□ Neglect
Please specify the number of times this type of critical incident occurred.
[.]
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
[.
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………
……………………………………………………………………………….]
□ Exploitation
Please specify the number of times this type of critical incident occurred.
[.]
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
[.
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………
……………………………………………………………………………….]
□ Hospitalizations
Please specify the number of times this type of critical incident occurred.
[.]
Of these hospitalizations, approximately how many occurred within 30 days of discharge
from a hospital or other institutional setting?
[.]

□ Emergency Room visits
Please specify the number of times this type of critical incident occurred.
[.]
Of these emergency room visits, approximately how many occurred within 30 days of
discharge from a hospital or other institutional setting?
[.]
□ Deaths determined to be due to abuse, neglect, or exploitation - During the current reporting
period, how many deaths occurring either in the current or previous reporting periods were
determined to be due to abuse, neglect or exploitation?
Please specify the number of times this type of critical incident occurred.
[.]
For each of these deaths, please describe the findings of the investigation and any actions
taken by the state:
[.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………...]
□ Deaths in which a breakdown in the 24-hour back-up system was a contributing factor During the current reporting period, for how many deaths occurring either in the current or
previous reporting periods did an investigation determine that a breakdown in the 24-hour
back-up system was a contributing factor?
Please specify the number of times this type of critical incident occurred.
[.]
For each of these deaths, please describe the findings of the investigation and any actions
taken by the state:
[.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………...]

□ Involvement with the criminal justice system
Please specify the number of times this type of critical incident occurred.
[.]
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
[.
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………
……………………………………………………………………………….]
□ Medication administration errors
Please specify the number of times this type of critical incident occurred.
[.]
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
[.
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………
……………………………………………………………………………….]

□ Other, specify below
Please specify the number of times this type of critical incident occurred.
[.]
Did the state make changes, either for the consumer(s) or its system, as a result of the
analysis of critical incidents?
[.
………………………………………………………………………………………………………
………………………………………………………………………………………...]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………
……………………………………………………………………………….]
□ None

11. Tribal Initiative Only - Describe any improvement(s) or challenge(s) related to the quality
management within the Tribal Initiative during this reporting period. Include reported critical
incidents as a subset of those identified in question 8. Describe the challenges related to the
development of adequate service plans, assessing risk implementing or assessing risk
mitigation strategies, addressing emergent risks in a timely fashion and delivering services
as specified in the plans.
[.
……………………………………………………………………………………………………………
…………………………………………………………………………….]
12. Tribal Initiative Only – Describe as a subset of the totals reported in questions 6, 7, 8, 9
and 10, the total number of participant deaths, circumstances surrounding the deaths,
critical incidents that occurred and nature of the incidents.
[.
……………………………………………………………………………………………………………
……………………………………………………………………………..]
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section (E.8).
[.
……………………………………………………………………………………………………………
…………………………………………………………………………………………………..]

E. 9. Housing for Participants
1. What notable achievements in improving housing options for MFP participants did your
program accomplish during the reporting period? Choose from the list below and describe
by target population for each checked box.
□ Developed inventory of affordable and accessible housing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Developed local or state coalitions of housing and human service organizations to identify
needs and/or create housing-related initiatives
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Developed statewide housing registry
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]

□ Implemented new home ownership initiatives
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Improved funding or resources for developing assistive technology related to housing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Improved information systems about affordable and accessible housing
Populations Affected
Older Adults

ID/DD

Other

□

□ Increased number of rental vouchers
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased supply of affordable and accessible housing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased supply of residences that provide or arrange for long term services and/or

supports
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements

□ Increased supply of small group homes
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Increased/Improved funding for home modifications
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

Please describe the achievements
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
□ None

2. What significant challenges did your program experience in securing appropriate housing
options for MFP participants? Significant challenges are those that affect the program's
ability to transition as many people as planned or to keep MFP participants in the
community. Choose from the list below and describe by target population for each checked
box.
□ Lack of information about affordable and accessible housing
Populations Affected
Older Adults

ID/DD

Other

□

□ Insufficient supply of affordable and accessible housing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Lack of affordable and accessible housing that is safe
Populations Affected
Older Adults

ID/DD

Other

□

□ Insufficient supply of rental vouchers
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Lack of new home ownership programs
Populations Affected
Older Adults

ID/DD

Other

□

□ Lack of small group homes
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Lack of residences that provide or arrange for long term services and/or supports
Populations Affected
Older Adults

ID/DD

Other

□

□ Insufficient funding for home modifications
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Unsuccessful efforts in developing local or state coalitions of housing and human services
organizations to identify needs and/or create housing related initiatives
Populations Affected
Older Adults

ID/DD

Other

□

□ Unsuccessful efforts in developing sufficient funding or resources to develop assistive
technology related to housing
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

100

3. How many MFP participants who transitioned to the community during the reporting period
moved to each type of qualified residence? The sum total reported below should equal the
number of individuals who transitioned to the community this period, reported in Question #4
(Transitions).
Older
Adults

ID/DD

Other

Total

Home (owned or leased by individual or
family)

Apartment (individual lease, lockable
access, etc)

Group home or other residence in
which 4 or fewer unrelated individuals
live

Apartment in qualified assisted living

4. Have any MFP participants received a housing supplement during the reporting period?
Choose from the list of sources below and check all target populations that apply.
□ 202 funds
Older Adults

ID/DD

Other

□

Older Adults

ID/DD

Other

□

□ CDBG funds

□ Funds for assistive technology as it relates to housing

Older Adults

ID/DD

Other

□

□ Funds for home modifications
Older Adults

ID/DD

Other

□

101

□ HOME dollars
Older Adults

ID/DD

Other

□

□ Housing choice vouchers (such as tenant based, project based, mainstream, or homeownership
vouchers)
Older Adults

ID/DD

Other

□

Older Adults

ID/DD

Other

□

□ Housing trust funds

□ Low income housing tax credits
Older Adults

ID/DD

Other

□

Older Adults

ID/DD

Other

□

□ Section 811

□ USDA rural housing funds
Older Adults

ID/DD

Other

□

□ Veterans Affairs housing funds
Older Adults

ID/DD

Other

□

102

□ Other, please specify
Older Adults

ID/DD

Other

□

□ None
5. Tribal Initiative Only - As a subset of the totals in question 3, report by population where
tribal members transitioned to as a result of the program.
Older
Adults

ID/DD

Other

Total

Home (owned or leased by individual or
family)

Apartment (individual lease, lockable
access, etc)

Group home or other residence in
which 4 or fewer unrelated individuals
live

Apartment in qualified assisted living

6. Describe specific housing efforts associated with this initiative and housing challenges
during this reporting period.
[.
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………..]
Use this box to explain missing, incomplete, or other qualifications to the data reported in this
section (E.9).
.

103

E.10. Employment Supports and Services
1. What types of ongoing employment supports are provided through your MFP program to
help participants find or maintain employment?
□ Job coaching or ongoing support planning
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
How is this service or support funded?
MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

□ Job training or re-training
Populations Affected
Older Adults

ID/DD

Other

□

Please describe by target population.
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
How is this service or support funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

104

□ Peer to peer consultation and support
Populations Affected
Older Adults

ID/DD

Other

□

□ Employment monitoring or mediation with employer/employees to resolve barriers to work
Populations Affected
Older Adults

ID/DD

Other

□

105

□ Mediation with family/friends to secure their support for individuals’ work-related needs
Populations Affected
Older Adults

ID/DD

Other

□

□ Assistance with transportation to and from work
Populations Affected
Older Adults

ID/DD

Other

□

106

□ Assistance with budgeting
Populations Affected
Older Adults

ID/DD

Other

□

□ Assistance developing interpersonal or employment skills
Populations Affected
Older Adults

ID/DD

Other

□

107

□ Other, specify below
Populations Affected
Older Adults

ID/DD

Other

□

2. What activities or progress was made this period to utilize MFP resources to support the
goals of MFP participants?
□ Hired employment specialists to help MFP participants achieve employment goals
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other
□ Produced training resources or delivered employment training to MFP staff, transition
coordinators, or waiver staff
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

108

□ Incorporated information about disability- and employment-related agencies and services
into outreach materials
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other
□ Financed services or supports (such as adaptive equipment, transportation, personal
assistance services) to help address barriers to employment
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

□ Leveraged Medicaid Infrastructure Grant program resources or funds (via supplemental
grants or no-cost extension of previous grants) to support employment of participants with
disabilities
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

□ Other, please specify
How is this activity funded?
□ MFP Demonstration Services
□ MFP Supplemental Services
□ MFP 100% Administrative Funding
□ Qualified HCBS
□ Other

□ None

109

3. What progress was made during the reporting period to establish collaborative relationships
with your state employment agencies (i.e., state departments of labor, vocational
rehabilitation, workforce development, or commissions for the blind)?
□ Participated in cross-agency awareness training
□ Participated in multi-agency working groups that address employment for individuals with
disabilities
□ Participated in state or local Workforce Investment Boards
□ Shared enrollment information to determine eligibility for services
□ Shared the costs of direct services for shared clients
□ Shared a database that allows the agencies to access one another’s intake and client
information
□ Other, Please specify [.……………………………………..]
□ None
4. Were there any other developments or progress this period toward increasing the availability
of employment services and supports for MFP participants?
[.
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………………………………………]
5. Tribal Initiative Only - Describe specific employment efforts associated with this initiative
and employment challenges during this reporting period.
[.
……………………………………………………………………………………………………………
……………………………………………………………………………..]

110

F. Organization & Administration
1. Were there any changes in the organization or administration of the MFP program during
this reporting period? For example, did your Medicaid agency undergo a reorganization that
altered the reporting relationship of the MFP Project Director?

□Yes
(If Yes) Please describe the changes.
[.
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………]

□No
2. What interagency issues were addressed during this reporting period?
□ Common screening/assessment tools or criteria
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ Common system to track MFP enrollment across agencies
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ Timely collection and reporting of MFP service or financial data
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ Common service definitions
Which agencies were involved?

[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]

111

□ Common provider qualification requirements
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ Financial management issues
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]

□ Quality assurance

Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ Other, specify below
Which agencies were involved?
[.
…………………………………………………………………………………………………………
…………………………………………………………………………..]
□ None

3. Did your program have any notable achievements in interagency communication and

coordination during the reporting period?

□Yes

(If Yes) What were the achievements in?

[.
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
…………………………………………………………………………………………]

□No

112

4. What significant challenges did your program experience in interagency communication and
coordination during the reporting period?
□ Interagency relations
Please describe the challenges. What agencies were involved?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Privacy requirements that prevent the sharing of data
Please describe the challenges. What agencies were involved?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

113

□ Technology issues that prevent the sharing of data

Please describe the challenges. What agencies were involved?

[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

□ Transitions in key Medicaid staff

Please describe the challenges. What agencies were involved?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]

114

□ Transitions in key staff in other agency
Please describe the challenges. What agencies were involved?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ Other, specify below
Please describe the challenges. What agencies were involved?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………..….]
What are you doing to address the challenges?
[.
……………………………………………………………………………………………………
………………………………………………………………………………………………...….]
What is the current status of the issue? □ Resolved □ In Progress □ Abandoned
(If Resolved or Abandoned) Explain status choice
[.
………………………………………………………………………………………………………
……………………………………………………………………………………………………...]
□ None
5. Tribal Initiative Only - Describe specific changes in organization or administration
associated with this initiative and any interagency challenges during this period.
[.……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
……………………………………………………………………………………………………………
………………………………………………………………]

115

G. Challenges & Developments
1. What types of overall challenges have affected almost all aspects of the program?
□ Downturn in the state economy
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Worsening state budget
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Transition of key position(s) in Medicaid agency
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Transition of key position(s) in other state agencies
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Executive shift in policy
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Other, specify below
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ None

116

2. What other new developments, policies, or programs (in your state’s long-term care system)
have occurred that are not MFP initiatives, but have affected the MFP demonstration
program’s transition efforts?
□ Institutional closure/downsizing initiative
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ New/revised CON policies for LTC institutions
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ New or expanded nursing home diversion program
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Expanded single point-of-entry/ADRC system
Please Describe
[[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ New or expanded HCBS waiver capacity
Please Describe
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ New Medicaid State Plan options (DRA or other)
Please Describe

[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]

117

□ New managed LTC options (PACE, SNP, other), or mandatory enrollment in managed LTC
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ Other, specify below
[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………]
□ None
3. Tribal Initiative Only - If not previously discussed, describe specific developments that you
want to highlight for this program including any challenges.

[.………………………………………………………………………………………………………
…………………………………………………………………………………………………………
……………………………………………………………………..]

118

H. Independent Evaluation
1. Is your state conducting an independent evaluation of the MFP program, separate from the
national evaluation by Mathematica Policy Research?

□Yes
(If Yes) Please explain.

[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………..]

□No
2. Were there any outputs/products produced from the independent state evaluation (if
applicable) during this period?

□Yes
(If Yes) Please explain.

[.
…………………………………………………………………………………………………………
…………………………………………………………………………………………………………
…………………………………………………………………..]

□No

119

I. State-Specific Technical Assistance
What type of state-specific programmatic TA did you receive during the reporting period? This could
include TA provided to a group of states. Do not use this section to report on all-grantee meetings or
events. Describe each type of issue (quality, housing, self-direction, other programmatic issues,
evaluation, and data management/submission; any others) and indicate how the TA was delivered
(group by teleconference, group in person, individual by telephone, individual in person, or peer-topeer). You may add more than one event of the same type to indicate different delivery methods.
TA Event #1:
Date

[

Type

Delivery Method

Describe the focus of the TA you received

Usefulness

If useful, describe what changed as a result. – if not useful, explain why.

TA Event #2:

Date

[

Type

Delivery Method

Describe the focus of the TA you received

Usefulness

If useful, describe what changed as a result. – if not useful, explain why.

120

TA Event #3:

Date

Type

Delivery Method

Describe the focus of the TA you received

Usefulness

If useful, describe what changed as a result. – if not useful, explain why.

TA Event #4:

Date

Type

Delivery Method

Describe the focus of the TA you received

Usefulness

If useful, describe what changed as a result. – if not useful, explain why.

TA Event #5:

Date

Type

Delivery Method

Describe the focus of the TA you received

Usefulness

If useful, describe what changed as a result. – if not useful, explain why.

121

Additional TA Events

122

J. Overall Lessons & MFP-related LTC System Change
1. Are there any other comments you would like to make regarding this report or your program during
this reporting period?

123

File Type	application/pdf
File Title	Money Follows the Person (MFP) Semi-Annual Progress Report
Subject	Money Follows the Person, semi-annual report, long-term care, Medicaid, home and community based services, MFP
Author	Mathematica Policy Research
File Modified	2018-08-21
File Created	2017-03-06