Reform Medicaid to Give People with Disabilities and older Americans Equal Access to Community-Based Services and Supports

Medicaid Community-Based Attendant Services and Supports Act (S. 1298)
Statement from Senator Tom Harkin (D-IA) and Senator Arlen Specter (R-PA)


More than ten years after the passage of the Americans with Disabilities Act, our Federal Medicaid policy fails to promote the law's basic principles of equality and independence. In order to go to work or live in their own homes, Americans with disabilities and older Americans need access to community-based services and supports. Unfortunately, under current Medicaid policy, the deck is stacked against community living.

States are already out ahead of the Federal government on this issue. Spending under the Medicaid home and community based waiver program has grown tenfold in the past ten years. Every State offers limited services under home and community based waivers and almost 30 States provide the personal care optional benefit through their Medicaid programs.

But there is a long way to go. Home and community based services and supports continue to be unevenly distributed within and across states and only reach a small percentage of eligible individuals. Depending on where you live or what type of disability you have, you may or may not have access to such services.

The numbers speak volumes. Even though more than 2 ‡ times more people are served in home and community-based settings than in institutional settings, only about 1/4 of Medicaid long term care funds went to pay for services and supports in home and community-based settings in FY 2000. And only 3 States spent 50% or more of their Medicaid long term care funds on home and community-based care.

The purpose of this bill is to level the playing field and give eligible individuals equal access to Medicaid community-based services and supports. Without this access, people with disabilities and older Americans do not have the real choice to live in the community near friends and family. They do not have the opportunity to access job opportunities. And, young adults with disabilities who have benefitted from special education services as children, are robbed of opportunities to contribute to the community and the workforce as adults.

Last year, Congress took a first step toward Medicaid reform by including substantial funding for systems change grants (included in Title II of this bill). Secretary Thompson has supported the development and implementation of these grants and has included them as part of the President's New Freedom Initiative for people with disabilities. States' strong response shows they need Federal help desperately. All but two of the eligible States and territories have submitted applications for these grants. Summary of Legislation

The Medicaid Community-Based Attendant Services and Supports Act (MiCASSA) requires States to provide equal access to community attendant services and supports for eligible individuals in need of long term services and supports. To help States phase in the community attendant benefit, an enhanced match rate will be available for community attendant services and supports for the next five years. In addition, the legislation provides financial assistance to States as they develop and enhance comprehensive statewide systems of long term services and supports to provide access to consumer-directed community-based services and supports in the most integrated setting appropriate.

The legislation would:

* Amend Title XIX of the Social Security Act (Medicaid provisions) to require States to provide a new Medicaid plan benefit that allows individuals who are eligible for nursing home and ICF-MR services to choose to receive community attendant services and supports.

* Provide an enhanced match rate for community attendant services and supports as States phase in the new benefit over the next five years. Also provide an enhanced match for certain administrative activities that will help States reform their long term care systems to support community-based services and supports and for services to eligible individuals who have above average costs.

* Make grants available to States to support ìreal choice systems change initiativesî that include specific action steps for the provision of consumer-directed community-based long term community services and supports.

* Establish a demonstration project to evaluate service coordination and cost sharing approaches with respect to the provision of community-based services and supports to individuals under the age of 65 eligible for both Medicaid and Medicare.