On April 7, the Senate Finance Committee examined proposals to improve access to home and community-based care for individuals with disabilities and the elderly.
Explaining that current law does not allow Medicaid to cover home- and community-based care as an alternative to inpatient care for mental health services, Chair Charles Grassley (R-IA) stated, “The elderly and people with disabilities and their families deserve a choice. They should have the ability to choose whether they prefer to live in the community or in a facility.”
The committee first heard testimony from Sen. Tom Harkin (D-IA), who highlighted his legislation to improve access to home- and community-based care. The Medicaid Community Based Attendant Services and Supports Act (S. 971) or “MICASSA” would require states to cover community-based services under Medicaid. The Money Follows the Person Act (S. 1394) would provide 100 percent federal funding for the first year of community-based services for people who have moved out of a nursing home or institution. After the first year, states would receive a 50 percent federal match for providing these services under Medicaid. Sen. Harkin explained that the bill is included in President Bush’s New Freedom Initiative, which aims to promote the full participation of people with disabilities in all areas of society. Arguing that states can save money by giving individuals greater choice, he concluded, “While we can put a dollar figure on cost savings, there is a much greater cost at stake here the cost in lost opportunities and dreams. When we passed the ADA [Americans with Disabilities Act], Congress created a vision of opportunity, equality, and independence. Current Medicaid policy is preventing that vision from being a reality for millions of older Americans and people with disabilities. They have waited 14 years since the passage of ADA for this injustice to end, and they should not have to wait any longer.”
Dennis Smith of the Centers for Medicare and Medicaid Services summarized the administration’s New Freedom Initiative. He explained that as part of the initiative, President Bush asked all federal agencies to evaluate their policies, programs, and regulations to determine whether they should be revised to improve access to community-based services for individuals with disabilities. Included in the initiative is the Living with Independence, Freedom, and Equality (LIFE) Savings Program that will “remove barriers to independence, community living, and participation in the labor force for Medicaid-eligible individuals with disabilities by giving them the opportunity to build savings for purchases that will increase their independence and productivity while also maintaining their vital health coverage and standard of living.” Mr. Smith said that the initiative also includes a number of demonstration projects to provide respite services to caregivers of children and adults with disabilities and home- and community-based services for children residing in psychiatric residential treatment facilities. He noted that the FY2005 budget proposal would allow Medicaid-eligible individuals to be covered even if their spouses participate in the Supplemental Security Income work incentive program; offer states the option of providing home- and community-based care to individuals for up to 90 days while Medicaid eligibility is being determined; and provide $40 million to continue assistance to states for the development of systems that support community-based care alternatives for all people with disabilities.
Testifying on behalf of the National Council on Disability, Carol Novak explained how the lack of home- and community-based services has negative consequences for children. “The lack accounts for unnecessary hospitalization of children and youth with emotional disturbances,” she stated. “It also contributes to readmission. For lack of services that might ease the transition from hospital to home, including respite services for their families, these children cycle back and forth between hospital and community without ever achieving stability.” Ms. Novak also noted that children who cannot get the mental health care they need often end up in foster care, the juvenile justice system, or an institution “where they are further cut off from support services.” Finally, she contended that the failure to identify and treat emotional disturbances is associated with the growing problem of teen suicide.