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MiCASSA Re-introduced in U.S. Senate
September 13, 2001
MiCASSA is back in front of the U.S. Senate. Senators Tom Harkin (D-IA) and Arlen Specter (R-PA) have re-introduced the Medicaid Community-based Attendant Services and Supports Act (S. 1298), and Senators Ted Kennedy (D-MA), Joseph Biden (D-DE) and Hillary Clinton (D-NY) have signed on as co-sponsors.
MiCASSA gives people real choice in long term care options by reforming Title XIX of the Social Security Act (Medicaid). The proposed reforms would eliminate a bias toward serving people with disabilities in institutions, rather than in community-based settings. MiCASSA allows individuals eligible for services in nursing facilities or Intermediate Care Facilities for the Mentally Retarded (ICF-MRs) the opportunity to choose instead a new alternative, "Community-based Attendant Services and Supports." The individual would be able to access community supports and services and the Medicaid funding would follow the individual.
In addition, MiCASSA offers states financial assistance to reform their long term service and support system to provide services in the most integrated setting.
What does the bill do?
- Provides community-based attendant services and supports ranging from assistance with:
 | activities of daily living (eating, toileting, grooming, dressing, bathing, transferring), |
| instrumental activities of daily living (meal planning and preparation, managing finances, shopping, household chores, phoning, participating in the community), |
| and health-related functions. |
- Includes hands-on assistance, supervision and/or cueing, as well as help to learn, keep and enhance skills to accomplish such activities.
- Requires services be provided in THE MOST INTEGRATED SETTING appropriate to the needs of the individual.
- Provides Community-based Attendant Services and Supports that are:
 | based on functional need, rather than diagnosis or age; |
| provided in home or community settings such as -- school, work, recreation or a religious facility; |
| selected, managed and controlled by the consumer of the services; |
| supplemented with backup and emergency attendant services; |
| furnished according to a service plan agreed to by the consumer; |
| and that include voluntary training on selecting, managing and dismissing attendants. |
- Allows consumers to choose among various service delivery models including vouchers, direct cash payments, fiscal agents and agency providers. All of these models are required to be consumer controlled.
- For consumers who are not able to direct their own care independently, MiCASSA allows for "individual's representative" to be authorized by the consumer to assist. A representative might be a friend, family member, guardian, or advocate.
- Allows health-related functions or tasks to be assigned to, delegated to, or performed by unlicensed personal attendants, according to state laws.
- Covers individuals' transition costs from a nursing facility or ICF-MR to a home setting, for example: rent and utility deposits, bedding, basic kitchen supplies and other necessities required for the transition.
- Serves individuals with incomes above the current institutional income limitation -- if a state chooses to waive this limitation to enhance the potential for employment.
- Provides for quality assurance programs that promote consumer control and satisfaction.
- Provides a "maintenance of effort" requirement so that states can not diminish more enriched programs already being provided.
- Allows enhanced match (up to 90% Federal funding) for individuals whose costs exceed 150% of average nursing home costs.
- Between 2001 and 2005, after which the services become permanent, provides enhanced matches (10% more federal funds each) for states which:
| begin planning activities for changing their long term care systems, and/or |
| include Community-based Attendant Services and Supports in their Medicaid State Plan. |
- Provides grants for Systems Change Initiatives to help the states transition from current institutionally dominated service systems to ones more focused on community based services and supports, guided by a Consumer Task Force.
- Calls for national five to ten year demonstration projects in five states to improve coordination of services for non-elderly individuals dually eligible for Medicaid and Medicare.
Learn more about MiCASSA! Visit the TASH website.
Substantial portions of this story were written by ADAPT.
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