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Pathways to Community Living - Legislative Fact Sheet

Background

The Pathways to Community Living Program is a long term care rebalancing initiative authorized by the Deficit Reduction Act of 2005 and administered by the Federal Centers for Medicare and Medicaid Services. The program is not a grant, it is a federal demonstration project nationally known as the Money Follows the Person Demonstration (MFP). It began in 2007 with an award to 30 states and was recently extended through September 2016 by the Affordable Care Act (Section 2403) with an award to an additional 13 states.

Illinois chose to rebrand MFP "Pathways to Community Living" to better represent the true meaning of the program. The program is directed by the Department of Healthcare and Family Services, in cooperation with the Department of Human Services, the Department on Aging, and the Illinois Housing Development Authority. The state agencies each contract with community providers who are responsible for assessing individuals in nursing facilities and assisting them with transitioning to the community.

What is the Goal of Pathways?

The program seeks to increase the use of community services and rebalance the state's long term care systems by providing appropriate, person-centered services for individuals interested in transitioning from nursing facilities to qualified home and community based settings.

Programmatic Objectives

Initial funds were made available by the federal Centers for Medicare and Medicaid Services in 2007. After the ACA extension through 2016 an additional $450 million was nationally appropriated for each fiscal year 2012-2016. However, funding is contingent on actual individuals transitioned to the community. Illinois receives one year of enhanced federal match on qualified Home and Community Based Waiver Services and state plan mental health services to individuals who transition through the program. This enhanced match must then be reinvested into strengthening Illinois' long term care system.

Program Components and Benefits

Transition coordinators work with qualified individuals to determine eligibility and ability to live in the community, and follow up for 365 days as an added community support.
Assistance is provided in locating eligible housing and with the actual move, including transition costs.
An individual plan is developed with consumers to determine necessary services and supports.

Consumer Eligibility Requirements

Targeted Population – Illinois has chosen to target four populations of individuals - those over age 60, with physical disabilities, with serious mental illness, or with intellectual/developmental disabilities.
Eligibility – Individuals must reside in a nursing facility for at least 90 days, be eligible for Medicaid, be able to be safely served in the community, and move to a qualified housing setting.