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Center for Integrated Programs (CIP)

Office of Consumer Access and Self Determination

Aging & Disability Resource Centers Program/No Wrong Door System

Find a Local ADRC

The Purpose of the Program and How it Works

The No Wrong Door (NWD) System initiative is a collaborative effort of the Administration for Community Living (ACL), the Centers for Medicare & Medicaid Services (CMS), and the Veterans Health Administration (VHA).  The NWD System initiative builds upon the Aging and Disability Resource Center program and CMS’ Balancing Incentive Program No Wrong Door requirements which support state efforts to streamline access to long-term services and support (LTSS) options for older adults and individuals with disabilities. NWD systems simplify access to LTSS, and are a key component to LTSS systems reform.

Finding the right services can be a daunting task for individuals and their family members. The current LTSS system involves numerous funding streams, and is administered by multiple federal, state and local agencies using complex, fragmented, and often duplicative intake, assessment and eligibility processes. There are more and more options for services and supports, in home, residential, and institutional settings. Individuals trying to access the multitude of new LTSS frequently find themselves confronted with a maze of agencies, organizations and bureaucratic requirements at a time when they may be vulnerable or in crisis. These issues frequently lead to the use of the most expensive forms of care, including institutional care such as nursing homes or extended hospitalization, and can cause a person to quickly exhaust their own resources.

NWD systems provide information and assistance not only to individuals needing either public or private resources, but also to professionals seeking assistance on behalf of their clients and to individuals planning for their future long-term care needs.  NWD systems also serve as the entry point to publicly administered long-term supports, including those funded under Medicaid, the Older Americans Act, Veterans Health Administration, and state revenue programs.

Since 2003, the Administration for Community Living (ACL) (formerly the Administration on Aging (AoA)) and CMS have been helping states streamline their processes and implement consumer-friendly systems that make it easier for consumers and their families to learn about and access the services they need. In these “No Wrong Door” Systems, multiple agencies at the state and local level coordinate to create a simplified process through which individuals of all ages, abilities, and incomes can get unbiased information and one-on-one counseling on the options available in their communities so they can make informed decisions on the services that best meet their needs, regardless of where they enter the system.   Consumers can also get assistance in accessing services, including help in completing applications for various public and private programs.

AoA and CMS awarded ADRC grants to 12 states in 2003, and each year the number of states participating in the program grew and eventually all states and several territories received funding to develop ADRC Programs. As the number of participating states grew, the ADRC initiative started to evolve, and several key functions were strengthened. For example, in 2008 the VHA—the nation’s largest health care system—recognized the value of ADRCs in helping consumers develop person centered plans (PCP) and direct their own care and began using the ADRC initiative to deliver the Veteran-Directed Home and Community Based Services program, giving Veterans the opportunity to self-direct their LTSS care and services. Another major development in the evolution of the ADRC model occurred in 2009, when care transitions were recognized as a functional component of the ADRC initiative. This work expanded again in 2010 when AoA made special grants available to 16 states to partner with hospitals to build evidence-based care transition programs into their ADRC programs. The capacity of ADRCs to help nursing home residents transition back to the community was significantly bolstered when state Medicaid agencies started to invest in ADRCs to assist with Money Follows the Person transitions. Under the new CMS guidance for MDS Section Q, many Medicaid agencies designated ADRCs to serve as a Local Contact Agency (LCA) to assist nursing home residents expressing a desire to return home.

Then, in 2010, the Patient Protection and Affordable Care Act provided $50 million dollars over five years to support the further development of the ADRC Program. The Affordable Care Act also funded the CMS Balancing Incentive Program to incentivize states to rebalance their Medicaid LTSS spending and required participating states to make changes to their LTSS systems, including developing statewide NWD programs.

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Recent Initiatives

Transforming State LTSS Access Programs and Functions into a No Wrong Door System for All Populations and All Payers

2014 Initiatives and Funding Opportunity Summary

In 2012, recognizing the accomplishments of both the ADRC and Balancing Incentive programs, as well as the lessons learned from the experience of states participating in these and other LTSS initiatives, ACL, in coordination with CMS and the VHA, issued a new Funding Opportunity Announcement—known as the 2012 “Part A: The Enhanced ADRC Options Counseling Program”—that reflected the key lessons learned to date. One of major learnings reflected in the Announcement was that no one agency or network could successfully implement a LTSS access system for all populations and all payers without having multiple agencies and organizations at the state and local level formally involved in the system's operations. Many different agencies and organizations that serve or represent the interests of different LTSS populations need to be involved. The new FOA embraced this lesson by officially adopting the “No Wrong Door” model.

Eight states (CT, MA, MD, NH, OR, VT, WI and WA) were awarded grants to develop a NWD System for all populations and all payers and to work with the federal partners on the development of national guidance and tools, including a national training program on Person Centered Counseling, that could be used by all states to develop NWD Systems for their citizens. Most recently, in 2014, building on the work of the Part A states, ACL, in coordination with CMS & VHA, awarded 25 states and territories one year grants to develop three year implementation plans that will guide the transformation of their multiple LTSS access programs and functions into a single statewide NWD System for all populations and all payers.

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Summary of Funding Opportunity Announcement

2015 NWD System Funding Description (at Grants.gov)

The U.S. Administration for Community Living along with the Centers for Medicare & Medicaid Services and the Veterans Health Administration is pleased to announce three year awards to 5 states building on the lessons learned of the original 8 states awarded in 2012.  State and local leaders can learn more about building capacity for No Wrong Door Systems by using the No Wrong Door National Key Elements (PDF, 2.05MB).

Nationally, NWD systems have taken important steps towards meeting ACL, CMS and VHA’s vision by:

  • Creating a person-centered approach that promotes independence and dignity for individuals;
  • Providing easy access to information and one-on-one counseling to assist consumers in exploring a full range of long-term support options; and
  • Providing resources and services that support the needs of family caregivers.

The funds being made available under this funding announcement will support 5 states who have been engaged in a state-led 12-month planning process identifying the key actions the state will need to take to move forward with the development and implementation of a single NWD System. Various state agencies were involved as full partners in leading the planning process, including State Medicaid Agencies; State Units on Aging; state agencies that serve or represent the interests of individuals with physical, intellectual, and/or developmental disabilities; and the state authorities administering mental health services.

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List of Awardees
STATE Applicant Agency Lead Agency or Agencies Three Year Request First Year Award Amount
Alabama
Alabama Medicaid Agency
Alabama Medicaid Agency
$2,361,638
$721,606
Colorado
Colorado Department of Health Care Policy & Financing
Colorado Department of Health Care Policy & Financing
$2,205,918
$723,823
District of Columbia
District of Columbia Department on Disability Services
Department of Health Care Finance, Department of Behavioral Health, Department on Disability Services, DC Office on Aging, Department on Human Services, and Office of Veterans Affairs
$2,174,777
$725,076
Hawaii
Executive Office of the State of Hawaii
Governor’s Office of Healthcare Transformation
$2,550,000
$850,000
Virginia
Virginia Department for Aging & Rehabilitative Services
Department for Aging & Rehabilitative Services
$2,542,135
$846,520

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Resources and Useful Links

ADRC Technical Assistance Exchange (TAE)
Sponsored by ACL, the ADRC TAE website provides training and technical assistance to states working on NWD systems. The ADRC TAE website includes summary information on state efforts, a variety of resources related to the development and implementation of NWD systems, and provides a forum for peer-to-peer information exchange on policy and program issues. In partnership with ACL, the ADRC TAE provides direct technical assistance to states and communities as they develop, implement and evaluate their NWD systems.

Find Local Resources System
This resource on the ADRC-TAE website allows consumers to find contact information for local NWD systems in their area.

Veterans Directed-HCBS Portal
This portal on the ADRC-TAE website features resources and information for VD-HCBS grantees and others serving Veterans.

No Wrong Door Newsletter
This weekly newsletter includes important NWD announcements as well as news, resources, and upcoming events of interest to NWD stakeholders. Please register for the newsletter if you wish to receive it.

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Last Modified: 3/7/2016