Money Follows the Person Rebalancing Demonstration (93.791)
Money Follows the Person Rebalancing Demonstration (Assistance Listing 93.791) is run by the Centers for Medicare and Medicaid Services, part of the Department of Health and Human Services. It awarded $2.2 billion in 44 grants from fiscal 2021 to 2025, about $50.8 million per award on average. No funding opportunity is open on Grants.gov right now.
The typical award was $20.5 million. Half of the 44 awards fell between $9.9 million and $74.3 million, and they ranged from $211,290 to $296 million.
- Awarded, FY 2021 to 2025$2.2 billion
- Grant awards44
- Typical award$20.5 million
- Awarded in FY 2025$567 million
- Size rank148 of 1,823
- Type of assistanceProject grants
Key findings
- Annual funding rose from $375 million in fiscal 2021 to $567 million in fiscal 2025.
- It is the 148th largest of 1,823 federal grant programs by five-year awards.
- The 20 largest recipients received 89% of the money.
- Awards went to recipients in 41 states and territories.
What the program funds
The Money Follows the Person (MFP) Rebalancing Demonstration, authorized by section 6071 of the Deficit Reduction Act of 2005 (P.L. 109-171), was designed to assist States to balance their long-term services and supports systems and help Medicaid enrollees transition from institutions to the community. Congress initially authorized up to $1.75 billion in Federal funds through Fiscal Year (FFY) 2011. With the subsequent passage of the Patient Protection and Affordable Care Act (P.L. 111-148) in 2010, section 2403 extended the program through September 30, 2016. An additional $2.25 billion in Federal funds was appropriated through FFY 2016. Since then, section 2 of the Medicaid Extenders Act of 2019 (P.L. 116-3) added $112 million in Federal funds and changed the end date for the program from September 30, 2016 to September 30, 2021. Section 5 of the Medicaid Services Investment and Accountability Act of 2019 (P.L. 116-16) changed the additional funding appropriated through the Medicaid Extenders Act from $112 million to $132 million and section 4 of the Sustaining Excellence in Medicaid Act of 2019 (P.L 116-39) changed the additional funding appropriated through the Medicaid Services Investment and Accountability Act from $132 million to $254.5 million. Section 205 of the Further Consolidated Appropriations Act, 2020 (P.L. 116-94) and section 3811 of the Coronavirus Aid, Relief, and Economic Security Act (P.L. 116-136) provided an additional $337.5 million. Section 2301 of the Continuing Appropriations Act, 2021 and Other Extensions Act (P.L. 116-159) added $66.4 million, section 1107 of the Further Continuing Appropriations Act, 2021, and other Extensions Act (P.L. 116-215) added $6.5 million. Section 204 of the Consolidated Appropriations Act, 2021 (P.L. 116-260) added $1.253 billion, extended and made changes to the program. The Consolidated Appropriations Act, 2023 (P.L.117-328) added $1.8 billion and extended the program through September 30, 2027. . As required by the Consolidated Appropriations Act, 2023, grant funds appropriated for each fiscal year must be awarded by the end of the following fiscal year. Funds awarded to MFP grant recipients are available for the fiscal year in which they are awarded plus four additional fiscal years. Any portion of a grant award that is unexpended by the state at the end of the fourth succeeding fiscal year shall be rescinded and added to the appropriation for the fifth succeeding fiscal year. The MFP Demonstration supports State efforts to rebalance their long-term services and supports system so that individuals have a choice of where they live and receive services. MFP program goals are (1) increase the use of home and community-based services (HCBS) and reduce the use of institutionally-based services; (2) eliminate barriers in State law, State Medicaid plans, and State budgets that restrict the use of Medicaid funds to let people get long-term services and supports in the settings of their choice; (3) strengthen the ability of Medicaid programs to provide HCBS to people who choose to transition out of institutions; and (4) put procedures in place to provide quality assurance and improvement of HCBS. The demonstration provides for an enhanced Federal Medical Assistance Percentage (FMAP) for 12 months for qualified home and community-based services for each person transitioned from an institution to the community during the demonstration period. Eligibility for transition is dependent upon residence in a qualified institution for more than 60 consecutive days. The State must continue to provide community-based services after the 12-month period for as long as the person needs community-based services and is Medicaid eligible. Under the demonstration, the State must propose a system of Medicaid home and community-based care that will be sustained after the demonstration period and is deemed qualified by the Secretary. Specifically, the program must be conducted in conjunction with a "qualified HCBS program" which is a program that is in operation (or approved) in the State for such individuals in a manner that assures continuity of Medicaid coverage of services in the qualified HCBS program for eligible individuals. States may also propose to enhance the services they will provide during the demonstration period to achieve greater success with transition. States are required to participate in a national qualitative and quantitative evaluation conducted by CMS. Data collected on a national level helps evaluate the core objectives of the statute.
Open opportunities
No opportunity under this program is open or forecast on Grants.gov right now. Programs often post once a year, so the funding history below shows what to expect.
Rules from the program listing
Who can apply
Applicants for this Demonstration Grant must be any single State Medicaid Agency, State Mental Health Agency, or instrumentality of the State. Only one application can be submitted for a given State. By "State" we refer to the definition provided under 45 CFR 74.2 as "any of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, any territory or possession of the United States, or any agency or instrumentality of a State exclusive of local governments." By "territory or possession", we mean Guam, the U. S. Virgin Islands, American Samoa, and the Commonwealth of the Northern Mariana Islands.
What the money can and cannot pay for
Indirect Costs: The provisions of the 2 CFR 225 (formerly OMB Circular A-87) govern reimbursement of indirect costs under this solicitation. A copy of OMB Cost Principles for State, Local, and Indian Tribal Governments is available online at https://www.grants.gov/learn-grants/grant-policies/omb-uniform-guidance-2014.html
Matching requirements
This program has no statutory formula. A State receiving an award under this solicitation will receive reimbursement for HCBS provided under the demonstration on a quarterly basis at the following FMAP rates: The FMAP rate was adjusted to reflect the increased FMAP available to States through the American Recovery and Reinvestment Act of 2009 each quarter from October 1, 2008 and extended by passage of Education, Jobs and Medicaid Assistance Act (P.L. 111-226) of 2010 through June 30, 2011. It is also adjusted to reflect the increased FMAP available through Section 6008 of the Families First Coronavirus Response Act (FFCRA), which provides for a temporary 6.2 percentage point FMAP increase to each qualifying state and territory’s FMAP under section 1905(b) of the Act, effective beginning January 1, 2020 and extending through the last day of the calendar quarter in which the public health emergency for COVID-19 declared by the Secretary of the Department of Health and Human Services, including any extensions, terminates. The funding for the increased FMAP is provided from Money Follows the Person grant demonstration appropriations. The enhanced FMAP provided by the DRA of 2005 (Enhanced Rate increased up to 50% of the State Match capped at 90%) is applied to the Recovery Act increased FMAP and the FFCRA increased FMAP as appropriate.
Deadlines
Contact the headquarters or regional location, as appropriate for application deadlines The deadline for applications a Planning Grant under the FY 2022 NOFO was May 31, 2022 , (3:00pm Eastern Standard Time).
Award range and average, in the agency's words
There is not a prescribed or predetermined maximum floor or ceiling grant award for States currently participating in the program. Each State is unique in the number of individuals that will be projected for transition under the demonstration grant. In addition, the costs of individuals transitioning to community settings may vary, by targeted population. Applicants are advised to request a grant award that is sufficient in the amount needed to transition the projected individuals into community settings. CMS reserves the right to reduce the requested grant award, based on the number and size of additional grant awards given under this demonstration, as well as because of concerns contained within a State's application (i.e., concerns with the number of costs of individuals projected for transition by the individual State. In March 2022, CMS released a Notice of Funding Opportunity (NOFO) to award planning grants to States not participating in the program. States that are awarded planning grants under the FY 2022 NOFO authorized under the Consolidated Appropriations Act of 2021 (CAA) can receive an award of up to $5 million; awards are anticipated to range between $4 million and $5 million per State. These funds will support the initial planning and implementation of the program.
Funding history and past recipients
From fiscal 2021 to 2025, Money Follows the Person Rebalancing Demonstration (93.791) awarded $2.2 billion across 44 grant awards, an average of $50.8 million per award.
Who usually wins
State and local governments received 98% of the money, colleges and universities 0.2%.
| Recipient type | Awards | Amount | Share |
|---|---|---|---|
| State and local governments | 42 | $2.2 billion | 98% |
| Other | 1 | $30.0 million | 1.3% |
| Colleges and universities | 1 | $4.8 million | 0.2% |
By state
40 states have a page for this program: those that received at least $1 million or 10 awards.
| State | Awards | Amount |
|---|---|---|
| Washington | 1 | $296 million |
| Massachusetts | 1 | $176 million |
| New York | 1 | $174 million |
| Minnesota | 1 | $165 million |
| California | 1 | $142 million |
| Connecticut | 1 | $141 million |
| Pennsylvania | 1 | $132 million |
| Texas | 1 | $116 million |
| Indiana | 1 | $84.4 million |
| Ohio | 1 | $78.2 million |
| Iowa | 1 | $75.2 million |
| New Jersey | 1 | $74.0 million |
| North Carolina | 1 | $61.6 million |
| Georgia | 1 | $52.9 million |
| North Dakota | 1 | $49.9 million |
| Louisiana | 1 | $43.6 million |
| Oklahoma | 1 | $40.5 million |
| Maryland | 1 | $31.2 million |
| Tennessee | 1 | $27.3 million |
| Colorado | 1 | $24.6 million |
| West Virginia | 2 | $23.7 million |
| South Dakota | 1 | $23.1 million |
| Missouri | 1 | $20.8 million |
| District of Columbia | 1 | $20.1 million |
| Alabama | 1 | $19.6 million |
| Vermont | 1 | $18.9 million |
| Wisconsin | 1 | $18.3 million |
| Rhode Island | 1 | $17.4 million |
| Idaho | 1 | $14.9 million |
| Kentucky | 1 | $11.8 million |
| Montana | 1 | $11.1 million |
| Arkansas | 1 | $10.1 million |
| South Carolina | 1 | $9.9 million |
| Maine | 1 | $9.7 million |
| Hawaii | 1 | $8.9 million |
| New Hampshire | 1 | $8.4 million |
| Nevada | 2 | $6.2 million |
| Puerto Rico | 1 | $5.0 million |
| Kansas | 1 | $5.0 million |
| American Samoa | 1 | $4.8 million |
| Mississippi | 1 | $211,290 |