CHALLENGES TO SUCCESSFUL TRANSITIONS FROM INSTITUTIONS TO LIVING IN THE COMMUNITY

The Money Follows the Person Rebalancing Demonstration (MFP) is a U.S. initiative helping states transition people needing long-term services and supports from institutional settings to the community in order to honor individual preferences and rebalance Medicaid expenditures. In Connecticut, MFP transition coordinators complete a standardized checklist of transition challenges for each individual during the transition process. Twelve challenge categories are recorded cumulatively until the person transitions, or if not transitioning, until the case closes. Quality of life surveys are completed at baseline, 6, 12, and 24 months after transition. This study examined transition challenges as predictors of successful transitions, including length of time to transition, risk of post-transition reinstitutionalization, and post-transition community integration. Analysis of challenge checklists (n=7021) indicates that persons whose cases closed without transitioning had significantly greater challenges relating to physical (OR=1.2) or mental health (OR=1.3), consumer engagement (OR=1.8), other involved individuals (OR=1.7), and home and community-based services (HCBS) programs (OR=1.5). For persons who transitioned, five challenges significantly (p