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Tag Archives: medicaid
Money Follows the Person (MFP)
Money Follows the Person (MFP) is a federal initiative whose goal is to move currently institutionalized persons with disabilities into home- and community based care. This is seen as a way to improve quality of life and enhance independent living for individuals, and to save federal and state Medicaid dollars. Idaho and other states are currently researching the design and implementation of MFP.
Check out the web site for the Welcome to the Housing Capacity Building Initiative for Community Living project here.
See also the Centers for Medicare and Medicaid Services description of MFP here.
Check back for additional resources and information regarding MFP.
Inclusive Design Gets Customers in the Door
By Erik Kingston, PCED
Download a one-page piece Visitability sheet here.
More and more single-family home buyers, builders and designers are recognizing the obvious: we’re all seniors or seniors in training (if we’re lucky), and each of us has friends, family members or neighbors with disabilities. We also understand that our mobility status can change in a heartbeat.
Single-family homes with zero-step entries create a more inclusive neighborhood and social network. Photo credit: www.visitability.org
Housing affordability strategy. Economists calculate a 60% probability that every newly built single-family detached home will house at least one disabled resident—and a 91% chance that each new home will welcome disabled visitors during its useful life. Modifying an inaccessible home can be cost-prohibitive, time-consuming, and difficult. Removing barriers like steps can add $10,000 to $50,000 to the cost of a home, and adding ramps creates logistical and aesthetic challenges. These represent a surcharge, or tax on homebuyers with an ambulatory disability.
“Designing for access adds value, not cost.“
According to the CDC, approximately 11% of Idahoans have a functional disability that limits mobility* but less than 1% of Idaho’s housing stock is accessible or ‘visitable.’ A lack of visitable single-family housing for rent or purchase is a barrier to independent living, community integration and productivity. This has broad and lasting individual and societal consequences.
Smart Business Practice. Think of it. What other industry would tell half its potential customer base, “our products are not for you or your friends and family; we don’t need your business?”
As with most innovation, visitable single-family construction will evolve through a combination of customer demand, builder savvy, and/or regulation. The demand is there, based on the number of folks with mobility-related disabilities who don’t need or want to live in an institution. Baby Boomers are aging, and we (and our parents) prefer the comfort and independence of living in homes that meet our changing needs.
“When addressed up front. Visitability is invisible.“
Builders who anticipate these needs will start building and marketing Homes for Life, just as they now build to LEED and “Super Energy Good Cents” standards to attract customers who want to save energy costs. Creative and visionary builders will lead the way to a sustainable housing market, either by acquiring and renovating existing properties or building new homes to Universal Design standards. Here’s what the American Planning Association has to say on the topic:
“We know that an overwhelming majority of older adults desire to remain in their current homes,” Peters says. “It makes sense to plan on someone having a mobility disability, whether due to accident, illness, or age.”
Simple, cost-effective construction guidelines. Some building professionals are reluctant to consider ‘one more standard.’ There are also many popular misconceptions about the costs of creating ‘visitability’ (which is far simpler than fair housing design and construction standards).
Thankfully, the pros at Visitability.org (formerly Concrete Change) and elsewhere have researched real-world costs to build or adapt homes, and offer a set of practical, easy to implement construction guidelines that highlight three basic features:
one zero-step entrance.
doors with 32 inches of clear passage space.
one bathroom on the main floor that someone in a wheelchair can enter and use with privacy.
Zero-step housing doesn’t involve building ramps; it relies on purposeful design, civil engineering and basic site prep to eliminate the need for a stepped barriers at the front, side or rear door. A zero-step entry may also connect the garage and main floor. In many cases, visitability can be achieved by simply specifying 2’10” or wider entry and passage doors.
By 2034, older adults will outnumber children. Improving the ‘Visitability; of new homes will benefit all.
Independent Living for Idahoans. The 2017 Assessment of Fair Housing (commissioned by Idaho Housing and Finance Association and Idaho Commerce) describes independent living this way.
“The most integrated setting is one that enables individuals with disabilities to interact with nondisabled persons to the fullest extent possible, consistent with the requirements of the Americans with Disabilities Act, 42 USC. 12101, et seq., and Section 504 of the Rehabilitation Act of 1973, 29 USC 794. See 28 CFR. part. 35, App. A (2010) (addressing 25 CFR 35.130).”
Under this principle, derived from the Supreme Court’s decision in Olmstead vs. L.C., institutionalized settings are to be avoided to the maximum possible extent in favor of settings in which persons with disabilities are integrated with nondisabled persons.
Increasing the percentage of accessible units—for rent or purchase—in Idaho’s overall housing inventory supports the goals we all share for independent living for ourselves and for our family members. This creates home- and community-based options for those looking to avoid or transition out of institutional settings, and in doing so, supports Idaho’s goals to address the promise spelled out in the 1999 Olmstead Decision.
The most recent 2022 Statewide Analysis of Impediments document reinforces the need to emphasize Visitability and inclusive design in our housing and neighborhoods:
There is growing evidence of the cost effectiveness of addressing accessibility needs of persons with disabilities proactively through good design and construction—rather than retrofitting units later.
The total cost to retrofit the estimated number of inaccessible homes in Idaho needed to meet the needs of people with disabilities (102,000) would be $408 million—$382 million more than what it would have cost to make these homes accessible when they were built. New construction design/build costs for purpose-built, zero-step single-family units are negligible, while modifications are typically cost prohibitive and can impact the home’s integrity and aesthetics.
Medicaid savings. There’s plenty of talk about saving Medicaid costs at the state and federal level. According to the Genworth Cost of Care Calculator, a Medicaid-eligible Idahoan with access to a visitable residence (essential for home-based care) saves Idaho’s Medicaid budget over the cost of institutionalized care—the default for someone without visitable housing. Institutionalized care billing is for 24/7 services, whether required or not.
Another term used to described the movement toward de-institutionalization of Medicaid-eligible individuals created under the Deficit Reduction Act of 2005 is Money Follows the Person, which ‘…supports state efforts for rebalancing their long-term services and supports system so that individuals have a choice of where they live and receive services.’ More visitable housing makes this possible.
This doesn’t even account for the quality of life issues and personal independence that come with living in your own home with family or friends. Those interested in maximizing outcomes from Medicaid investments might consider advocating for housing that is both affordable and accessible.
Inclusive neighborhoods. Nearly all single-family subdivisions are built with stepped entries at the front, side and rear doorways—even a step between the garage and living space.
One homebuyer (a local executive who uses a wheelchair) reflected on the broader social implications of design barriers after purchasing a brand-new home in a Boise subdivision:
“My wife and I couldn’t find a single accessible home in our brand new subdivision, but we were able to have one designed and built. Sure, it means my home is accessible, but if a neighbor invites us to dinner or asks me to look after their pets while they’re away, I have to say no. I don’t think people know how isolating this can be, or how easy it is to design and build in access up front.” —Jeremy Maxand, E.D., Living Independence Network (LINC)
Demographic changes. Wheelchair users are not all seniors. Wounded warriors, athletes and professionals all want housing that is close to services, retail, recreation and culture and that allows them to live independently. They represent a strong market for well-designed and well-built housing that can be used by anyone, whether they currently have a disability or not.
Market demand and potential. A growing segment of home buyers demand zero-step entry homes—and more accessible and inclusive neighborhoods—for themselves and their family members, and to ensure they can remain in their homes, whatever life brings. Some housing industry professionals recognize this and are meeting the demand. An example is Bay Area Realtor Stephen Beard, host of the Accessible Housing Matters podcast (“the intersection of disability and housing”), which featured a September 2021 interview with the Idaho Access Project. Stephen has made a niche for his real estate business by serving the needs of a large client base seeking homes that meet their access needs now and into the future.
Consumer perspectives. Ask anyone searching for housing usable by someone who relies on a wheelchair or other mobility device. They’ll likely tell you steps are a deal-breaker when it comes to renting or purchasing a home. Learn more in the videos below.
One features Jeremy, who describes how he and his wife had their home built to Visitability standards in a Boise subdivision at no additional cost.
Learn more. Below are examples of how we get to the point of equal access and independent living. To add more news, send an email to and type ‘accessible future’ in the subject line. Let’s do it.
Concrete Change, a national leader is visitable home design and modification, is now www.visitability.org* and hosted by the National Council for Independent Living, or NCIL.
*Note. The former Concrete Change web site contained several helpful resources that may not all be available at Visitability.org site, although a .pdf version of a portion of the original material is linked below:
Accessible Housing Matters, a podcast hosted by Realtor Stephen Beard, features interviews with industry professionals, architects, builders, homeowners and advocates addressing design, construction, marketing and demand for housing with accessible features.
Idaho Access Project is an Idaho-based nonprofit working to eliminate physical, attitudinal, and policy barriers to ensure people with disabilities can live, work, and play in our neighborhoods and communities. They are seeking partnerships with architects, builders and developers interested in creating visitable subdivisions.
Information from the National Association of Home Builders
Home For Life, a virtual tour from Remodeling Magazine demonstrating how to create or modify a home for the rest of your life.
Ramp Up Idaho, an initiative to raise awareness of the tax advantages and opportunities to expand small business retail activity by removing barriers to access.
