Dear listmember:
It's estimated that currently 75% of Medicaid long term care funding goes
to nursing home care. S.1935 (MiCASSA) would redirect more funds into
community based care, and give consumers more choice in the type of care
they receive. As Helen and Charlotte said - please write to your
senators.
Linda

From NRCA website:
                   [National Rehabilitation Counseling Association]
                         LEGISLATIVE UPDATE ARCHIVE
Posted on November 19, 1999

     Harkin, Specter Introduce MiCASSA

     Senators Tom Harkin (D-Iowa) and Arlen Specter (R-Pennsylvania).
     have introduced  MiCASSA  in the Senate as bill number S. 1935.

     Senator Tom Harkin Medicaid Community Attendant Services and
     Supports Act Introductory Statement November 16, 1999

     Mr. President.  Today, along with Senator Arlen Specter, I am
     introducing the Medicaid Community Attendant Services and
     Supports Act.  Our bill allows people to have a real choice about
     where they receive certain types of Medicaid long term services
     and supports.  It also provides grants to the States to assist
     them as they redirect Medicaid resources into community-based
     services and supports.

     We all know that given a real choice, most Americans who need
     long term services and supports would rather remain in their own
     homes and communities than go to a nursing home. Older people
     want to stay in their homes; parents want to keep their children
     with disabilities close by; and adults with disabilities want to
     live in the community.

     And yet, even though many people prefer home and community
     services and supports, our current long term care program favors
     institutional programs. Under our current Medicaid system, a
     person has a right to the most expensive form of care, a nursing
     home bed, because nursing home care is an entitlement.  But if
     that same person wants to live in the community, he or she is
     likely to encounter a lack of available services, because
     community services are optional under Medicaid.  The deck is
     stacked against community living, and the purpose of our bill is
     to level the playing field and give people a real choice.

     Our bill would allow any person entitled to medical assistance in
     a nursing facility or an intermediate care facility to use the
     money for community attendant services and supports. Those
     services and supports include help with eating, bathing,
     grooming, toileting, transferring in and out of a wheelchair,
     meal planning and preparation, shopping, household chores, using
     the telephone, participating in the community, and health-related
     functions like taking pills, bowel and bladder care, and tube
     feeding. In short, personal assistance services and supports help
     people do tasks that they would do themselves, if they did not
     have a disability.

     Personal assistance services and supports are the lowest-cost and
     most consumer friendly services in the long-term care spectrum.
     They can be provided by a variety of people, including friends
     and neighbors of the recipient.  In many instances, with
     supervision, the consumer can direct his or her own care and
     manage his or her own attendants. This cuts down on expensive
     administrative overhead and the current practice of relying on
     medical personnel such as nurses to coordinate a person's care.
     States can save money and redirect medically-oriented care to
     those who need it most.

     Not only is home and community-based care what people want, it
     can also be far less expensive.  There is a wide variation in the
     cost of supporting people with disabilities in the community
     because individuals have different levels of need.  But, for the
     average person, the annual cost of home and community based
     services is less than one-half the average cost of institutional
     care. In 1997,  Medicaid spent $56 billion on long term care. Out
     of that $56 billion,  $42.5 billion was spent on nursing home and
     institutional care.  This paid for a little over 1 million
     people. In comparison, only $13.5 billion was spent on home and
     community-based care but this money paid for almost 2 million
     people.  Community services make sound, economic sense.

     In fact, the States are out ahead of us here in Washington on
     this issue. Thirty States are now providing the personal care
     optional benefit through their Medicaid programs.  Almost every
     State offers at least one home and community based Medicaid
     waiver program. Indeed, this is one of Senator Chafee's most
     important legacies.  He was ahead of his time.

     The States have realized that community based care is both
     popular and cost effective, and personal assistance services and
     supports are a key component of a successful program. And yet
     there are several reasons why we have to do more.

     Federal Medicaid policy should reflect the consensus that
     Americans with disabilities should have the equal opportunity to
     contribute to our communities and participate in our society as
     full citizens.  Instead, our current federal Medicaid policy
     favors exclusion over integration, and dependence over
     self-determination.  This legislation will bring Medicaid policy
     in line with our broader agreement that Americans with
     disabilities should have the chance to move toward independence.
     This bill allows people to receive certain types of services in
     the community so that they don't have to sacrifice their full
     participation in society simply because they require a catheter,
     assistance with medication, or some other basic service.

     Take the example of a friend of mine in Iowa.  Dan Piper works at
     a hardware store.  He has his own apartment and just bought a
     VCR.  He also has Down's syndrome and diabetes.  For years Dan
     has received services through a community waiver program.  But,
     he recently learned that he might not be able to receive some
     basic services under the waiver.  The result of this decision?
     He may have to sacrifice his independence for services.  Today,
     Dan works and contributes to the economy as both a wage earner
     and a consumer.  But, tomorrow, he may be forced into a nursing
     home, far from his roommate, his job and his family.

     In addition, our country is facing a long-term care crisis of
     epic proportions in the not-too distant future.  We all talk
     about the coming Social Security shortfall and the Medicare
     shortfall, but we do not talk about the long-term care
     shortfall.  The truth is that our current long-term care system
     will be inadequate to deal with the aging of the baby boom
     generation, the oldest of whom are now turning 60.  Our bill
     helps to create the infrastructure we will need to create the
     high-quality, community based long term care system of the
     future.  And it will give families the small amount of outside
     help they need to continue providing care to their loved ones at
     home.

     And, finally, in a common sense decision last June,  the Supreme
     Court found that, to the extent Medicaid dollars are used to pay
     for a person's long term care, that person has a right to receive
     those services in the most integrated setting.  States must take
     practical steps to avoid unjustified
     institutionalization by offering individuals with disabilities
     the supports they need to live in the community.  We in Congress
     have a responsibility to help States meet the financial costs
     associated with serving people with disabilities that want to
     leave institutions and live in the community, and the bill I am
     introducing will provide that help.

     And so I call upon my colleagues for your support. Millions of
     Americans require some assistance to help them eat, dress, go to
     the bathroom, clean house, move from bed to wheelchair, remember
     to take medication, and to perform other activities that make it
     possible for them to live at home. These Americans live in every
     State and every congressional district. Most of these people have
     depended on unpaid caregivers - usually family members - for
     their needs.  But a number of factors have affected the ability
     of family members to help.  A growing number of elderly people
     need assistance, and aging parents will no longer be able to care
     for their adult children with disabilities.

     But they all have one thing in common with every American.  We
     all deserve to live in our own homes, and be an integral part of
     our families, our neighborhoods, our communities.  Community
     attendant services and supports allow people with disabilities to
     lead richer, fuller lives, perhaps have a job, and participate in
     the community.  Some will become taxpayers, some will do
     volunteer work, some will get an education, some will participate
     in recreational and other community activities. All will
     experience a better quality of life, and a better chance to take
     part in the American dream.

     I urge my colleagues and their staff to study our proposal over
     the break. I hope there will be hearings and action on this bill
     next year.  And, finally, I ask unanimous consent that the bill,
     along with letters in support of the bill, be printed in the
     Record following our statements.