Puerto Rico Long Term Services and Support System - Puerto Rico (PR) is in a unique situation. Because current federal Medicaid funding methods cap both total federal funds and the federal “match rate,” the Puerto Rico Medicaid Program (PRMP) does not cover institutional or community-based Medicaid-funded long-term services and supports (LTSS). Until this inequity is addressed PR will focus on planning for and beginning capacity building activities to develop the entire LTSS continuum emphasizing home and community-based services (HCBS). Money Follows the Person (MFP) Grant activities will not initially focus on transitions from institutional care. The need in PR is significant. The population is aging quickly, but there is little access to HCBS or institutional LTSS. Families provide most care due to both necessity and cultural preference. Caregivers report considerable need for additional support. While the lack of LTSS is problematic, it also allows PR to learn from other states and develop a system without needing to “undo” institutional bias. The PR Department of Health (PRDoH), the State Medicaid Agency, will use the $4,998,037 Grant funds for a thorough needs assessment (Assessment), technical assistance (TA), and planning non-emergency medical transportation (NEMT). PR expects to primarily use contractors for these functions, supported by four full-time staff. Coordinated with a stakeholder Advisory Committee, and using surveys, focus groups, and interviews, the Assessment will inform other Grant activities and allow PR to build system capacity, prepare an implementation plan, identify strategies for service development, and secure resources needed to implement LTSS and ultimately MFP. The Assessment will review the needs of all applicable populations but will focus on the elderly and disabled. Both urban and rural areas will be assessed. The Assessment will review gaps and needs related to all services that would form a complete Medicaid-funded LTSS continuum. The availability of direct service workers will be evaluated. TA will draw on this Assessment and lessons from other states. The TA contractor will describe options and make capacity building and implementation recommendations within allowable Medicaid authority. The resulting plan will inform PR and federal stakeholders of the funding and other resources needed to implement an LTSS system, identify and begin to implement action steps to build system capacity, and prepare for eventual full implementation of LTSS designed to reduce barriers, address gaps, and comply with Medicaid requirements. Areas addressed with respect to planning, TA, and capacity building will include beneficiary eligibility, provider requirements, electronic visit verification, quality measures, case management, worker and caregiver training, high-level program budgets, identifying and planning for system enhancements, and whether LTSS should be provided under PR’s comprehensive managed care system. Additionally, because of insufficient federal funding PR does not have a Medicaid-funded NEMT system. Adequate transport is a key component of a well-functioning HCBS system, and planning for such a system and building capacity to implement it will be included in Grant activities. Because PR does not currently have Medicaid-funded LTSS and is not expected to transition beneficiaries as part of its activities under this grant, many Implementation Phase components do not apply. However, all implementation needs will inform both the Assessment, TA, and capacity building. The MFP grant is expected to yield significant positive results. PR will help ensure the Assessment and TA identify and prioritize initiatives that can be implemented with no or limited additional funding. PRMP will build stronger partnerships with governmental and community organizations. Most importantly, PR will be able to move quickly when funds become available
