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Living in the Community, not Institutions
Tools for People with Disabilities and Advocates
article compiled by Phil Jordan, substantial portions taken from Steve Gold's Treasured Nuggets of Information
September 26, 2002
Olmstead. It means people with disabilities having real choices about how they want to live their lives.
MiCASSA. It means people with disabilities get the supports they need to live in their own homes.
Nursing Home. It means segregation for people with disabilities. It means being trapped where you have no option of community living.
Money Follows the Person. It means you can get Medicaid coverage and still live in your own home.
Read on . . . . . . . . . . . . . . . . . . .
Olmstead
People with disabilities have been warehoused in nursing homes and other institutions for years, often against their will. Since 1999, when the Supreme Court issued its opinion in the landmark case, Olmstead v. L.C., people with disabilities have been demanding that states develop plans to address the Olmstead decision and provide opportunities for community living (to learn more about the Olmstead decision).
One of the problems faced by states in making community living options available for people with disabilities relates to healthcare. The Medicaid program provides healthcare for many people with disabilities, and Medicaid will pay nursing homes and other institutions for the healthcare provided in those settings. Unfortunately, Medicaid will often not pay for healthcare services when the person lives in a community setting - in their own home! That is why MiCASSA is so important.
MiCASSA
The Medicaid Community Attendant Services and Supports Act, or MiCASSA, would change the rules about how Medicaid pays for healthcare for people with disabilities. It would change the law to remove the “institutional bias” of Medicaid, and allow people to get their healthcare coverage when they live in the community. ADAPT, a national disability-rights organization has been the leader in trying to get MiCASSA passed in the U.S. Congress (to learn more about the fight for MiCASSA, visit the ADAPT website, or see previous articles in Envoy On-Line about MiCASSA in Envoy Archives).
One of the great things about MiCASSA is that it will save the government money to provide healthcare services in people’s homes, rather than in an institution. Since that is true, why is MiCASSA having such a hard time getting passed?
The Nursing Home Lobby
The answer to that question is troubling. The Nursing Home industry is opposed to MiCASSA because they will lose customers. U.S. News and World Report recently did a story that explains why. Among the interesting tidbits of information about the industry:
 | The nursing home industry is profitable - and growing. Many nursing homes are earning exceptionally healthy profit margins, often 20 and 30 percent. |
| There is no strong evidence, as the industry claims, that low Medicaid payments for care are dragging down profits. |
| Even as they report tough financial times in their official government filings, many nursing home operators steer big chunks of their revenues to themselves or related businesses before they calculate the bottom line. |
| Our federal taxes fund two thirds of all nursing home care ($58 billion last year). Nearly two thirds of nursing homes are for-profits (see "Nursing Home Ownership - Information Bulletin #23",click on Archives). |
| There is no relationship between a nursing home's profits (or the size of its losses) and the portion of its patients covered by Medicaid. Let's not forget that ALL persons in nursing homes have disabilities, whether they are 35, 55, 75, or 90 years old. The nursing homes are profiting off the disability community. |
Financial tricks similar to Enron's (self-dealing, exporting profits from a local nursing home to a parent corporation) were cited in the article. It does not matter whether the nursing facility is for-profit or not for-profit. The tricks are the same.
Read the entire article from U.S. News and World Report
Federal government tells the states to comply with Olmstead
[Reprinted from Steve Gold Information Bulletin #37]
Many folks have been struggling with their Governors and State Medicaid departments to force compliance with the Olmstead decision -- that is, to compel states to stop the unnecessary segregation of people with disabilities in nursing homes and to mandate providing to persons with disabilities the "real choice" of living in their homes and communities with appropriate services.
This summer Tommy Thompson, Secretary of the U.S. Department of Health and Human Services (HHS), the federal agency that funds all the home and community-based waivers and also funds nursing homes, made several important announcements that you should use in your local struggles to implement the Olmstead decision.
On August 12, 2002, he wrote to all state governors that "We believe there is a tremendous opportunity to serve people ... in their own homes or other community residential settings without increasing costs." He suggested, based on what some states have already implemented, programs that the feds have already approved “under existing [federal] authority.” The three programs are:
- Money Follows the Person model -- whatever amount your state pays the nursing homes should "follow the person" to be used in the community. The Secretary acknowledged that when the money follows the person it "assures stability of community living." The Money Follows the Person model is a tremendous handle for advocates! It accomplishes several goals at one time, including equalizing the amount spent on the individual regardless of the location, stopping states from using waivers that are substantially less than what is paid in the nursing home for the same person, and sets up some good old fashion competition. Since your State is already spending the money on the person in the nursing home, they can't say it is a budget issue! Move the money from the nursing home budget to the community budget. It’s that simple.
- Diversion programs to keep people in the community. This recognizes that Olmstead applies to persons in the community and not those who are institutionalized. Also, it recognizes that once people go into the institution, many people psychologically seem to lose their self-confidence that they have the skills and ability to live in their own homes. Providing services before the person is institutionalized also mitigates the housing problems. Independent living centers can be points of diversion by marketing themselves as places that can pull together the various support services to keep folks in the community and "independent."
- Transition programs to move persons from nursing homes to community placements. With regard to this, on May 9, 2002, in a "Dear State Medicaid Director" letter, HHS included as appropriate reasonable costs for "community transition services," the following:
| Security deposits to obtain a lease; |
| Essential furnishings and moving expenses required to live in the community; |
| Set-up fees or deposits for utility services. |
| Read "Dear State Medicaid Director" letter |
We've been fighting for these for years and now HHS agrees. Your State has to select to put "transition costs" into your waiver program. They may not do it if you do not give them a nudge!
These three programs provide advocates with an awesome opportunity. The feds are telling us to force your states to do these three and the feds will approve these programs. There are NO EXCUSES that your Governors or Medicaid directors can give you!
DON'T MOURN. ORGANIZE
Steve Gold, The Disability Odyssey continues . . .
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