Money Follows the Person Rebalancing Initiative California Community

Money Follows the Person Rebalancing Initiative: California Community Transitions CALIFORNIA FOUNDATION FOR IDEPENDENT LIVING CENTERS STATEWIDE MEETING FEBRUARY 27, 2016

CCT Overview • Primary goal is to reduce the number of Medi-Cal recipients receiving long-term care (≥ 90 days) in inpatient facilities by arranging for the use of home and community-based (HCB) services. • Local care coordination organizations work directly with willing and eligible individuals to transition them back home or to the community. • CCT Project services are funded through Sept. 30, 2020. – CCT transitions to be performed through December 31, 2018 – CCT follow-up services to be performed through December 21, 2019 2

Total Number of CCT Transitions 482 489 2012 2013 530 493 356 231 131 2009 2010 2011 2014 2015 3

CCT Transitions by Provider Type 2008 - 2015 1020 669 780 224 ILCs Other Community Dept. of Orgs Developmental Services HHAs 4

CCT Participants by Target Population 41% Elderly PD DD/ID MI 32% 25% 1% Total 5

CCT Post-Transition HCBS 2008 - 2015 28% 11% 6% Informal Support 25% 29% IHSS Only NF/AH 1% Other Waiver ALW DD Waiver 6

Housing Outcomes by Target Population Home Apartment ALW Group Home Elderly 13% 30% 57% 1% PD 18% 60% 22% 1% DD/ID 7% 8% 0% 85% MI 23% 41% 36% 0% All 4 Target Populations 13% 36% 25% 26% 7

1 -year CCT Post-Transition Status 2008 -2015 85% Remained in Community 7% 7% Died Re-Institutionalized 1% Other 8

Sustainability Planning • HCBS Advisory Workgroup to identify and adapt the best practices in CCT. • Statewide training on person-centered counseling. • Less-burdensome authorization and payment structures that allow providers to meet immediate needs of Participants, in real time. • Improved cross-discipline collaboration. • Expanded flexibility in HCBS waivers for coverage of tenancy-based support services. 9

Nursing Facility / Acute Hospital (NF/AH) Waiver Renewal HOME AND COMMUNITY-BASED (HCB) ALTERNATIVES WAIVER 10

Home and Community Based (HCB) Alternatives Waiver • Renewal of the former Nursing Facility/Acute Hospital Waiver • Key Changes – Increase in waiver size • Will provide additional slots for the current and potential future needs – Increase in cost caps • The waiver will be shifting from an individual cost limit to an aggregated cost limit across the entire waiver. In other words, individuals will no longer be assigned a specific cost cap 11

HCB Alternatives Waiver (continued) • Key changes continued – Localizing waiver administration • The state will be contracting with waiver agencies (WAs) to perform waiver administration • These agencies will be responsible for providing case/care management or contracting out for this service • See handouts for additional information 12

Questions? Karli. Holkko@dhcs. ca. gov 13