Congressional Quarterly - Disabled People Want More Choice in Types of Care

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http://www.cqpolitics.com/wmspage.cfm?docID=hbnews-000002656258

CQ HEALTHBEAT NEWS
Jan. 16, 2008 – 6:24 p.m.
Disabled People Want More Choice in Types of Care

By Emily P. Walker, CQ Staff

Dozens of people with disabilities packed a House Energy and Commerce hearing room on Wednesday to support legislation that aims to give people with disabilities more choice about their care.

“Individuals with disabilities deserve care when and where they decide,” said Jan Schakowsky , D-Ill., a member of the Health subcommittee, which held the hearing on Medicaid’s role in caring for people with disabilities.

On Monday, the Centers for Medicare and Medicaid Services (CMS) issued a proposed regulation that the agency said would allow more Medicaid beneficiaries to be in charge of their own personal assistance services rather than relying on an agency to deliver them. CMS has requested public comment on how states could allow Medicaid beneficiaries who need help with the activities of daily living to hire, direct, train or fire their own personal care workers. Beneficiaries could hire qualified family members to perform the personal assistance services, CMS said. (See related story, CQ HealthBeat, Jan. 14, 2008)

Medicaid only covers for community care for adults if the disabled person is transitioning into the community after being in a nursing home. For instance, Medicaid allows states to pay for case managers, but only to help transition Medicaid beneficiaries from a nursing home institution to the community. Medicaid is piloting another program that rewards states for transitioning people with disabilities into the community, but requires the person to have been in a nursing home for at least six months beforehand. “You should not have to go in to get out,” said Stephanie Thomas, an organizer with ADAPT, a grass-roots disability rights organization. “Sixty-seven percent of Medicaid long-term funds go toward institutions, and just 33 percent are left for community services,” she said. Shifting some funding away from nursing home institutions and toward community services could save money, Thomas said, because nursing home care cost is more expensive. “We could be serving three people for every two we are serving now, and doing it more humanely,” she said.

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