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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 settings.

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.