1. Maryland Access Points and Money Follows the Person Lorraine Nawara Office of Health Services Maryland Department of Health and Mental Hygiene

2. Existing Waivers Maryland will serve MFP participants using five home and community-based waiver programs –The Traumatic Brain Injury (TBI) waiver Serves adults in chronic hospitals and State-owned nursing facilities –The Community Pathways (CP) waiver Serves adults with developmental disabilities –The New Directions (ND) waiver Self-directed waiver for adults with developmental disabilities –The Living at Home (LAH) waiver serves people with physical disabilities between 18 and 65 –The Older Adults Waiver (OAW) serves adults with disabilities over the age of 50

3. Transition Goals ElderlyMR/DDPhys DisTBITotal 200700000 20085335722162 2009108881286330 20101531712311304 20111842013512351 20122202014915404 20132642016315462 20143172018015532 20153812019815614 20164572021715709 Total213726013671063870

4. Rebalancing Initiatives Increase outreach to institutional residents –Peer Outreach –Program Education –Application Assistance Improve the transition process –Enhanced Transitional Case Management –Housing Assistance Enhance existing community-based services –Peer Mentoring –New Waiver Services –Behavioral Health Improve Systems –Statewide ADRC sites

5. Peer Outreach Peer is defined as an older adult or person with a disability who has utilized long-term supports and services or an individual with non-professional life experience with long- term supports and services Peer visit nursing facilities and attempt to contact all Medicaid-eligible residents –Only targeting criteria is LTC Medicaid eligibility Introduce the idea that residents can choose to receive their services in the community Share their own experience with community-based long term care services

6. Peer Outreach Outreach contracts require attempts to reach 80% of Medicaid-eligible nursing facility residents per quarter 20,000 residents in 223 facilities 15,359 contacted, in-person, to date MMIS data on Medicaid recipients provided to contractors via a web-based MFP tracking system

7. Program Education Provided by Area Agencies on Aging Program Education (PE) is an in-person contact with the resident to provide in-depth information about Medicaid and other home and community-based services –PE can consist of several meetings and phone calls to educate the individual and their representatives –Includes details of medical, financial, and technical eligibility, time frames, and process Results in Application Assistance if the resident would like to pursue the transition to the community

8. Program Education Outcomes 3,993 individuals referred for PE since July 1, 2009 3,320 individuals received education 1,028 individuals received assistance to complete applications for HCBS Last quarter there were over 250 waiver applications submitted from nursing facilities 60% increase in applications from institutions

9. Peer Mentoring Provides a range of supports –Improving access to the local community –Increasing community inclusion –Informing consumers of community opportunities –Promoting community integration May include –Travel training –Self-advocacy skills training –Referrals to accessible community resources Provided by the Centers for Independent Living

10. Housing Assistance Training provided to waiver case managers –Increase awareness –Encourage referrals to housing waiting lists 5 new housing specialists at DHMH –Map available resources –Identify housing for transition candidates Planning 2 new housing policy positions to focus on development of new opportunities Maryland awarded 112 NED Category II Vouchers

11. MFP and Section Q MFP program is the Local Contact Agency for Section Q Referrals translated into Program Education referrals Three MAP sites creating partnership to respond to referrals –AAA completes PE for MA-eligibles –Peers from the CILs complete PE for non-MA eligibles 269 manual referrals received since 10/1/10 –164 of the referred were not MA-eligible –Assessment data indicates over 1,000 potential referrals per quarter once process is automated

12. Maryland Access Point MDoA was awarded as an ADRC Grantee in 2003 11 current sites, mostly county-based Goal is to have 20 sites covering the entire state by the end of 2012 State-level Partners MD Dept. of Aging Dept. of Health & Mental Hygiene Dept. of Human Resources MD Dept. of Disabilities Statewide Independent Living Council Local Partners Area Agency on Aging Local Health Dept. Dept. of Social Services Other County government agencies Centers for Independent Living

13. MAP Sites New Projects are funded through the MAP sites –Community Living Program (formerly NH Diversion) –Person-Centered Hospital Discharge Planning –Veteran-Directed Home and Community-based Services Program –AoA grant for MDS 3.0 and Peer Supports –MFP Services Several MAPs have co-located county services and CIL partners to improve collaboration

14. MFP and MAP Utilizing MFP Rebalancing funds to expand MAP sites –Requiring funded relationships with disability partners AoA grant to develop best practices for peer supports at MAP sites –CILs and AAAs collaborating to develop standards across multiple programs –Piloting the use of peers to respond to MDS 3.0 Section Q referrals Developing universal standards of practice for Education –Information and Referral/ Information and Assistance/ Program Education Services Utilizing the MAP sites as the vehicle to continue MFP services post-demonstration

15. Opportunities Partnerships Streamlining access and process Incorporate institutional transition and diversion into MAP model Develop best practices and universal standards for all sites, across partners and agencies Incorporate independent living philosophy and peer support model into Aging Network

16. Questions? Lorraine Nawara MFP Project Director Office of Health Services, DHMH (410) 767-1442 NawaraL@dhmh.state.md.us