Congressman Davis Talks About the Community Choice Act

Congressman Davis Talks About the Community Choice Act

This year marks the 17th anniversary of the Americans with Disabilities Act and it is entirely appropriate and consistent that we now have before the Congress H.R. 1621, the Community Choice Act. The Americans with Disabilities Act was truly a landmark piece of civil rights legislation which ushered in a new era of promise for a segment of our population whose talents and rights as American citizens have been too long ignored. It established a new social compact that seeks to end the paternalistic patterns of the past that take away our rights if we become disabled. It says that people with disabilities have the right to be active participants integrated into the everyday life of society.

Much like the promise of the 1965 Civil Rights Act, however, the promise cannot become a reality until we roll up our sleeves and do the work necessary to eliminate the barriers, which still hinder its full implementation. While some recent decisions of the Supreme Court have threatened the scope of the ADA, I would like to call our attention to a Supreme Court ruling that reaffirms the fundamental principle that people with disabilities have the right to be active participants integrated into the everyday life of society. In 1999, the Court ruled in the Olmstead case that states violate the Americans with Disabilities Act when they unnecessarily put people with disabilities in institutions. The problem is that our Federal-State Medicaid Program has not been updated and has a built-in bias that results in the unnecessary isolation and segregation of many of our senior citizens and younger adults in institutions.

In the case of Medicaid beneficiaries who need long-term support services, the only option currently guaranteed by Federal law in every State is nursing home care. Too often decisions relating to the provision of long-term services and supports are influenced by what is reimbursable under Federal and State Medicaid policy rather than by what individuals need and deserve. Research has revealed a significant bias in the Medicaid program toward reimbursing services provided in institutions over services provided in home and community settings. Other options have existed for decades but their spread has been fiscally choked off by the fact that 75% of our long term care dollars go to institutional settings, in spite of the fact that studies show that many people do better in home and community settings.

The Community Choice Act is precisely the tool both the States and consumers need to obtain more cost effective long-term services in the most appropriate setting for the individual. Instead of creating a new entitlement, the Community Choice Act makes the existing entitlement more flexible. It amends Title 19 of the Social Security Act and creates an alternative service called Community Attendant Services and Supports. This allows individuals eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded, regardless of age or disability, the choice to use these dollars for ``Community Attendant Services and Supports.''

These attendant services and supports range from assisting with activities of daily living, such as eating, toileting, grooming, dressing, bathing and transferring, as well as other activities including meal planning and preparation, managing finances, shopping and household chores.

Quality assurance programs, which promote consumer control and satisfaction, are also included in this bill. The provision of services must be based on an assessment of functional need and according to a service plan approved by the consumer. It also allows consumers to choose among various service delivery models including vouchers, direct cash payments, fiscal agents and agency providers.

Some have argued that such a flexible and consumer friendly option would bring people who need these services ``out of the woodwork'' and make our Medicaid costs skyrocket. This bill has been put together based on what we have learned from pilot programs and best practices throughout the States. Oregon and Kansas have data to show that fear of skyrocketing costs is blown out of proportion. While there may be some increase in the number of people who use this option at first, savings will be made on the less costly community based services and supports, as well as the decrease in the number of people going into institutions. The bill also allows states to limit the total amount spent on long-term care in a year to what the state would have spent on institutional services.

Whether a child is born with a disability, an adult has a traumatic injury or a person becomes disabled through the aging process, we can and must do better in offering our citizens the kind of long term care services they need and deserve.

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