CONTACT: MELVIN O. SHAW
300 Plaza Centre One
Iowa City IA 52242
(319) 384-0010; fax (319) 384-0024
Release: Aug. 13, 2001
UI researcher: Senate bill eliminates institutional care bias
IOWA CITY -- Heather Ritchie, researcher at the University of Iowa's Law,
Health Policy and Disability Center, says a recently reintroduced U.S. Senate
bill to provide community-based attendant services to older Americans and
individuals with disabilities would help eliminate institutional bias against
such people who require some form of personal care assistance. The bill would
also provide choice in the delivery of services at a level that currently
does not exist, Ritchie says.
Under Senate bill S. 1298, the Medicaid Community Attendant Services and
Support Act (MiCASSA), people who are entitled to nursing facility or intermediate
care facility services through Title XIX of the Social Security Act -- Medicaid
provisions -- would be eligible for funding in the community at the same level
as the cost of institutionalization. The bill provides for consumer-directed
home and community-based services including personal care, such as meal preparation,
bathing, grooming, and health-related services, such as assistance with medications
or ventilator care.
Research by the U.S. Department of Health and Human Services (HHS) found
that evidence of a funding bias in favor of "large congregate settings"
compared to in-home and community-based services. HHS also found that Medicaid
benefit packages provided in group settings are medically oriented and create
barriers to the types of services a majority of individuals need and want.
The research showed evidence of a bias in that 75 percent of Medicaid funds
for long-term services and supports is disbursed to institutional care facilities
such as intermediate care facilities for the mentally retarded and nursing
homes, compared to approximately 25 percent for in-home services and community-based
MiCASSA would allow individuals in need of personal care to live independently,
to contribute and to be a part of their community and mainstream society,
says Ritchie, a doctoral student in the UI's School of Social Work. The enactment
of MiCASSA would be a dramatic change in the way personal care is now delivered
by increasing choice in long-term care services and providing a model that
promotes consumer control. In most cases, community care costs less than institutional
care and would have the effect of moving society closer to providing services
in the most integrated setting as required under the Americans with Disabilities
Act, Ritchie said.
MiCASSA would require states to offer community-attendant services for Medicaid
eligible people. The bill defines eligible services and supports, allows consumers
to choose payment methods and service models such as vouchers, direct cash
payments, intermediary fiscal agents and agency providers, and provides for
quality assurances. To be eligible for MiCASSA funding, each state would have
to establish a governor-appointed task force composed of people with disabilities
and other stakeholders to assist in the development, implementation and evaluation
of service delivery models.
MiCASSA empowers consumers with control over their schedules, and would
be suitable for young and old people who want opportunities and choices in
their lives. Nursing homes should continue to be an option for people and
their families, but without greater funding for community services, many do
not have a choice, Ritchie says.
U.S. Sens. Tom Harkin and Arlen Specter first introduced MiCASSA in 1997,
and are now joined by Sens. Hillary Rodham Clinton, Edward Kennedy and Joseph
Biden in support of the bill.