DEPARTMENT OF HEALTH & HUMAN SERVICES 
Health Care Financing Administration  
 Center for Medicaid and State Operations 
7500 Security Boulevard 
Baltimore, MD 21244-1850 
Feb. 16, 1999  
Dear State Medicaid Directors:  
I am writing to you today to seek your input on elements that we should consider including in our 1999 grant solicitation 
entitled "Nursing Home Transition Initiative". This is not a request for proposals.  
The Health Care Financing Administration (HCFA) is announcing a new 1999 grants program entitled "Nursing Home 
Transition Initiative". As specified in the House Conference Report for Making Omnibus Consolidated and Emergency 
Supplemental Appropriations for Fiscal Year 1999 (HR 4328), these grants will assist States to continue carrying out 
demonstration projects to transition persons out of nursing homes by ensuring, where appropriate, coverage of 
community-based attendant care services for people with disabilities which ensures maximum control by the consumer to 
select and manage their attendant care services. HCFA is making $2 million available for this initiative and anticipates 
selecting four to six State Medicaid agencies as grantees. Grant awards made to individual States will range from 
$333,000 to $500,000. The projected date for release of the solicitation document to the public is April 1999. The 
projected due date for the proposals to HCFA is the end of June 1999. Awards will be made during September 1999.  
The primary focus of this grant initiative is to encourage States to develop and implement new processes for identifying 
beneficiaries who can be safely transitioned into the community and for establishing community support systems for 
them.  
States will have considerable flexibility to develop innovative projects that address:  
(cid:131)  identification of beneficiaries in nursing facilities that are capable of living successfully in the community with 
appropriate supports;   
(cid:131)  the development of community-based services/supports for persons who are institutionalized;   
(cid:131)   elimination of incentives to keep beneficiaries institutionalized;   
(cid:131)  fostering the independence of the beneficiary in the community, including the selection and management of 
community-based services such as attendant care;   
(cid:131)  the development of innovative funding arrangements which enable money to follow the individual;   
(cid:131)  the empowerment of beneficiaries, families, and advocacy groups through partnerships and coalitions with 
providers and policy makers to design and implement appropriate service delivery models that maximize 
consumer choice and direction.   
HCFA is also requesting input and advice from the public, advocacy groups and the disability community on elements to 
be included and ways to structure the grant solicitation document. While HCFA cannot guarantee that it will be able to 
adopt all suggestions in its grant solicitation, it will give careful consideration to all comments received.  
Please forward all input to the project officer for this grant, Thomas Shenk, at fax number 410/786-9004 or e-mail to 
tshenk@hcfa.gov no later than March 15, 1999. All readers of this announcement are encouraged to disseminate this 
information to interested parties in order to achieve the widest distribution of this notice as possible.  
Sincerely,  
Theresa A. Derville  Acting Director  Disabled and Elderly Health Programs Group  
cc:  All HCFA Regional Administrators  
All HCFA Associate Regional Administrators for Medicaid and State Operations  
Lee Partridge  American Public Human Services Association  
Joy Wilson  National Conference of State Legislatures  
Jennifer Baxendell  National Governors' Association