Increasing successful returns to community living from nursing facilities through the Money Follows the Person program: Mechanisms for reducing disparities for older adults with dementia

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Most people living with Alzheimer’s disease and Alzheimer’s disease-related dementias (PLWD) prefer to remain at home in the community, yet research shows that they are less likely than people without Alzheimer’s disease and Alzheimer’s disease-related dementias (AD/ADRD) to successfully return to the community following nursing facility stays. Medicaid’s Money Follows the Person (MFP) program has successfully helped over 100,000 individuals return to community living after nursing facility stays, and Connecticut has one of the highest rates of participation among over 40 participating states. Research finds PLWD have decreased access to the MFP program and lower odds of successfully moving out of nursing facilities, yet it is unknown what mechanisms are leading to these disparities. This study asks why these disparities exist and what is causing them in order to identify policy levers to improve equity for PLWD. We will also analyze differences by race and ethnicity, based on evidence that in Connecticut non-Hispanic Black and Hispanic MFP participants are more likely than non-Hispanic White participants to complete moves back to the community. Using a mixed-methods approach we will identify individual, family, organizational, and community factors which influence three distinct outcomes: applications submitted to the MFP program, completed moves from nursing facility to community homes, and sustained community living. The study’s three aims include: Aim 1: in-depth interviews with individuals with and without AD/ADRD and their informal caregivers to identify barriers and facilitators of their participation and success in MFP; Aim 2: asking staff involved in each step of the MFP program about mechanisms contributing to different experiences for PLWD and potential levers for change; and Aim 3: identifying how mechanisms such as individual health, family support, and organizational practices contribute to disparities in MFP applications, completed moves, and sustained community living through quantitative analysis of approximately 55,000 Connecticut Medicaid nursing facility residents. This study builds upon our team’s 14+ years as the evaluator of the state’s MFP program, our long-standing relationship with Connecticut’s Department of Social Services (the state Medicaid administrator) which is enthusiastic about improving health equity in MFP for this population. The study also leverages a constellation of rich MFP data collected by and uniquely accessible to our team and merges it with Medicaid and Medicare claims data and Minimum Data Set (MDS) data to create a powerful analytic dataset for analyzing MFP outcomes. The study is innovative in conceptualization of three outcomes representing different potential points where disparities emerge along the MFP process continuum, taking advantage of rich untapped and unique data on the MFP program and participants, and an academic-government research partnership with a commitment from our state policy partner who is ready to modify Connecticut’s MFP program to improve health equity for PLWD.