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.