System Transformation

• To be eligible for Money Follows the Person an individual must:
  • Be enrolled in Medicaid
  • Be 18 years of age or older
  • Reside in a qualified institution (i.e. Intermediate Care Facilities for Individuals with Intellectual Disabilities, Regional Mental Health Institute, or Nursing Home) for sixty (60) days
  • Have care needs that can be adequately met in a community setting
  • Transition to the community in the CHOICES program, Employment and Community First (ECF) CHOICES program, or other waiver Home and Community Based Services (HCBS).

Money Follows the person (MFP) is a long-standing grant-funded demonstration designed with four goals:

• Increase the use of HCBS rather than institutional LTSS under Medicaid;
• Eliminate barriers or mechanisms that prevent or restrict the flexible use of Medicaid funds to enable Medicaid-eligible individuals to receive support for appropriate and necessary LTSS in the settings of their choice;
• Increase the ability of state Medicaid programs to assure continued provision of HCBS to eligible individuals who choose to transition from an institutional to a community setting; and
• Ensure that procedures are in place to provide quality assurance for eligible individuals receiving Medicaid HCBS and to provide for continuous quality improvement in such services.

• Money Follows the Person (MFP) FAQs
• Money Follows the Person (MFP) Flyer
• TennCare Community Living Supports (CLS) LookBook
• MFP Members might be eligible for additional benefits:
  • Supplemental Nutritional Assistance Program (SNAP). To learn more about SNAP, visit the Department of Human Services for Supplemental Nutrition Assistance Program (SNAP).
  • Vocational Rehabilitation (VR). To learn more about VR, visit the Department of Human Services for Vocational Rehabilitation.

Questions? Contact us at the LTSS Help Desk 1-877-224-0219

Money Follows the Person

The support you need to live where you want. You have a say in how and where you want to live.

Are you or a loved one currently living in an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID)? Do you want a choice in how and where you live? Keep reading to find out how Tennessee’s Money Follows the Person (MFP) can help.

What is Money Follows the Person? Also called MFP, this is a demonstration funded by the federal government that helps Medicaid eligible individuals living in Intermediate Care Facilities (ICF/IID's) transition back into the community.

Who is eligible? You may be able to enroll in MFP if you are: Medicaid-eligible; in an ICF/IID, Nursing Facility, or other qualified institution for sixty (60) days; and transitioning to the community in the CHOICES, Employment and Community First (ECF) CHOICES, or other waiver Home and Community Based Services (HCBS). Keep in mind, additional eligibility criteria for other waiver HCBS will apply.

How does it work? MFP provides the funds based on your needs. Funds pay for services and support you need for a successful transition into the community. Housing options include your own home, individual apartments or Community Living Support (CLS) Homes. You and your care team will work together to develop a plan that's right for you.

What does MFP pay for? MFP pays for your care in the community. It also pays for other expenses related to a person moving into a more independent setting. You may be eligible to receive more help. MFP may help with home modifications, short term rental assistance and security deposits, along with one-time setup costs for a new apartment.

What kind of support and care can I expect? Your care plan depends on your needs. A care management team will assess what level of care will provide a safe transition to the community. Your Transition Coordinator will work with you and your care team to help find a place for you to live. They will also help find service providers such as nurses, physical therapists, or home health aides in your community.

How long does it take? Each timeline to transition is different. You and your coordinator will work together and they will advise you on what to expect.

Do I have a say? Yes! You are the most important person in this process. If you are happy with your living arrangement, you can choose to stay where you are. At each stage of the process, you have the choice of whether or not to continue.

How do I learn more? This FAQ gives a brief outline of the Money Follows the Person demonstration. To find out more, talk to your transition team. Or read more on this page under Money Follows the Person (MFP).

Questions? Call 1-877-224-0219

In Tennessee, the "Money Follows the Person" (MFP) demonstration is designed to support individuals transitioning from institutional settings to community-based settings, emphasizing independence and quality of life. Below is one member’s story of how they utilized the MFP funding.

Following a four-month long hospital stay, Tiffany McCauley, age 24, found herself at a crossroads. She had limited family support and few community resources to rely on to help her. She faced the challenge of starting over without an income or adequate support for rent, household items, or food.

Using MFP funding, Tiffany was able to transition to a Community Living Support- Family Model (CLS-FM) residence. Although the transition to her new living situation was challenging, the MFP funding and resources provided the crucial support she needed. Tiffany received assistance with essential items for her new home, including food and hygiene products. This support was instrumental in helping her settle in and begin anew. The program’s support allowed Tiffany to focus on her personal goals and embrace her independence. Tiffany explains, “I now have access to what I need in my life, and I’m able to work on achieving the goals that are important to me.” Her advice to others considering a big transition like hers is to stay positive and recognize the value of the resources available. “It will help you restart your life and stay on track.”

Tiffany’s story showcases her courage and the profound impact of supportive care. Her growth and independence continue to inspire those around her.

In Tennessee, the "Money Follows the Person" (MFP) demonstration is designed to support individuals transitioning from institutional settings to community-based settings, emphasizing independence and quality of life. Below is one member’s story of how they utilized the MFP funding.

In 2023, Natasha experienced a mental health crisis while living in Employment and Community First (ECF) CHOICES Community Living Supports (CLS). This crisis resulted in her hospitalization, where she faced symptoms such as catatonia, lack of responsiveness, uncontrollable body movements, contractures in her ankles and feet, and psychosis. Over the ensuing months, Natasha was transferred among various hospitals and nursing facilities where her condition gradually improved. Recognizing the need for additional support, she and her family decided to explore the Family Model option within Community Living Supports, hoping to find an approach to meet her evolving needs.

Through Money Follows the Person (MFP), Natasha received essential items for her new home, including food, clothing, furniture, and hygiene products. She adapted quickly and is extremely fond of her new surroundings. Natasha has enjoyed outings to the lake, ballgames, and restaurants. With physical and occupational therapy, she gained greater independence, moving from relying on a Hoyer lift to transferring herself between chairs and her bed.

A recent milestone for Natasha was regaining the ability to wear shoes again, overcoming the drop foot caused by her earlier condition. Natasha also loves going to the salon and getting her hair done.

Since 2020, Natasha has made amazing strides in her health, mental well-being, and independence. Natasha’s journey is a reminder of the importance of community support. With the ongoing support of ECF and MFP, she is determined to achieve her goals of having her own apartment and returning to work!

In Tennessee, the "Money Follows the Person" (MFP) demonstration is designed to support individuals transitioning from institutional settings to community-based settings, emphasizing independence and quality of life. Below is one member’s story of how they utilized the MFP funding.

For over three decades, Leslie’s life was shaped by the confines of an Intermediate Care Facility (ICF), where she lived alongside eight other individuals. Since 1990, her nights were restless, often interrupted by the sounds of a roommate who yelled through the night, making a full night's sleep a distant dream. Despite the challenges of Cerebral Palsy, Leslie always dreamed of living on her own in an apartment, free from the presence of third-shift staff. Through funding from “Money Follows the Person”, Leslie was able to realize this dream and transition into the community and into her own home. On December 20, 2024, Leslie took a big step by moving from the ICF to a Community Living Services (CLS) home. This wasn’t just moving to a new place; it was a major step toward her goal of being independent.

Although Leslie requires staff assistance with daily activities like transferring, eating, toileting, and bathing due to contractures and limited muscle control, she has never been alone on her journey. She navigates life with a powerchair controlled by a joystick and communicates using a Tobi DynaVox with advanced eye-gaze technology. Leslie's mother has also been an unwavering advocate, fully supporting her daughter's journey to independence.

Recognizing how important technology was in Leslie's life, her team at Wellpoint worked with an Enabling Technology provider to set up essential supports in her apartment. They installed a tablet on her headboard so she could easily reach remote support when needed. A Smart Button was added for 911 emergency calls, and smoke and carbon monoxide detectors were placed to alert staff in case of an emergency. Sensors on doors and windows provided extra security, while a bed rail ensured Leslie's safety without interfering with her use of the technology.

Leslie is excited about the next chapter in her life and the opportunities ahead. She is eager to explore employment opportunities and becoming more engaged in her community. Leslie is also working to refine her skills with the Tobi DynaVox while sharing her experiences as a member of the Money Follows the Person advisory board.

Leslie's journey is a powerful beacon of hope for others in similar circumstances. Her life has undergone remarkable changes, and she continues to inspire those around her with courage and determination.

Enhanced Respiratory Care services in nursing facilities are reimbursed using a system that measures quality outcomes to adjust rates based on the facility’s performance on key performance indicators.

• TennCare Plan for Improving Enhanced Respiratory Care Quality
• ERC Operations Manual
• Enhanced Respiratory Care (ERC) Program Flyer

Are you thinking about providing Enhanced Respiratory Care (ERC) services in a nursing facility in Tennessee?

This information outlines TennCare reimbursement for these services that you may want to consider.

1. To be eligible for TennCare reimbursement of ERC services in a nursing facility, the facility must be:

a. Dual certified by the Centers for Medicare and Medicaid Services for the provision of Medicare Skilled Nursing Facility and Medicaid Nursing Facility services; and

b. Licensed by the Tennessee Board for Licensing Health Care Facilities

2. In addition to licensure requirements for all nursing facilities in Tennessee, there are specific licensure requirements that pertain to facilities providing ventilator care, see TennCare Rules 1200-08-06-.06(12).

3. These licensure requirements are applicable regardless of payer source (Medicare, Medicaid, etc.)

4. To be eligible for TennCare reimbursement of ERC services, there are additional standards—for ventilator care and for tracheal suctioning. These standards are available at: TennCare Rules 1200-13-01-.03(5).

5. Even if a facility is dual certified and licensed for the provision of ventilator care, it does not obligate a TennCare MCO to contract with such provider for ERC reimbursement.

6. If a facility does not have a contract with the TennCare MCO specifically for ERC reimbursement (not just Medicaid NF services), it will not be eligible for ERC reimbursement for any of the MCO’s members in that facility, even if the member has an approved Pre Admission Evaluation for such level of reimbursement.

7. A moratorium is in place on new TennCare contracts for ERC reimbursement except when an exception is requested by an MCO and granted by TennCare based on the MCO's demonstration of the need for additional capacity or improved quality in the geographic area in which the NF is located.

8. At a minimum, TennCare review of requests for exception to the moratorium will take into account:

a. The need for increased quality or capacity in the region to be served;

b. The organization’s experience in delivering ERC services – documentation of outcomes is recommended;

c. The organization’s CMS Five-Star quality rating and history of clinical and survey performance;

d. The organization’s timeline for becoming a fully functional Medicaid ERC facility, if approved – this includes construction, licensure, operational site, adequate staffing and equipment, etc., and

e. The results of a site visit by the MCO or its contracted ERC experts that will include an assessment of facility readiness and care quality.

9. ERC reimbursement is an add-on payment to the facility’s per diem rate. The amount of the add-on payment is based on the facility’s performance on quality outcome and technology measures. Facilities must demonstrate high quality in order to be eligible for higher levels of payment. These quality expectations must be understood and modeled by a potential vent care provider.

10. For a newly TennCare contracted ERC facility, at least six (6) months of quality outcome and technology performance data on all ERC patients must be submitted in order to determine the facility’s quality tier and the facility’s add-on payment for ERC reimbursement. This requires a minimum of six (6) months of quality performance data, regardless of payer source. Until the ERC payment amount can be established, the facility will be reimbursed at the facility’s established rate for Medicaid NF services.

11. To express an interest in becoming a TennCare ERC provider, please e-mail the ERC mailbox. We can provide MCO contacts so you can initiate discussions with them in order to discern TennCare contracting potential.

12. More information about TennCare’s Enhanced Respiratory Care Quality Improvement Initiative. Note that some of the information in that document has changed as the initiative has evolved.

• If you have questions about the Nursing Facility QuILTSS program, please contact us at: QUI.LTSS@tn.gov
• If you have questions about the Enhanced Respiratory Care Program, Please contact us at: ERC.LTSS@tn.gov