On May 20, 2010, Cindy Mann, the new CMS Director issued a "Dear Medicaid Director." She reminded each State Medicaid Director that "in the Olmstead decision [in 1999], the Supreme Court held that unjustified institutional isolation of people with disabilities is a form of unlawful discrimination under the ADA." "The demand for community services continues to grow, and many individuals in need of these services struggle without them. In addition, State budget constraints threaten the progress that has been achieved, raising concerns about compliance with the ADA and Olmstead."
The Dear Medicaid Director letter provides your State with information "on new tools for community integration, as well as to remind States of existing tools that remain strong resources" to end the unlawful discrimination. [The letter can be downloaded. Google CMS and Dear Medicaid Director letter.]
Here is a partial list of those tools. Does your State use them all?
* CMS offers technical assistance to States to support greater ommunity-based system capacity to "advance opportunities for the full community inclusion of all individuals" and for quality in home and community based services [HCBS]. Has your State asked CMS for any technical assistance?
* MS provides technical assistance to States for properly implementing PASRR [Preadmission Screening and Resident Review] so that people with mental illness and intellectual disabilities are not dumped into nursing facilities.
* Identifies a technical assistance guide entitled Long Term Services and Supports in a Managed Care Delivery System' so States could make sure community-based services were integral to those services.
* Identifies three opportunities for States to advance access to affordable housing as a means to maximize community living. Has your State applied for any of these?
* Notes that Section 1915(i) permits your State to provide HCBS as a State plan option to service persons with disabilities in the community without linking the benefit to either a current or future need for institutional care. CMS pointed out that the 2010 Affordable Care Act [i.e., health reform legislation] expanded this section and "offers great promise as a tool to prevent instituitonalization." Has your State applied for this?
* Notes that Section 1915(j) permits your State to provide "self-directed personal assistance or other HCBS for individuals who would otherwise receive State plan personal care or HCBS waiver services." Has your State applied for this?
* Reminds States that Medicaid's state plan Personal Care optional benefit "can play an important role in supporting people in their homes and communities, provide necessary help to care givers and can prevent or delay the need for institutional care."
* Reminds your State that the "self-direction service delivery model is available under many MA authorities.... Self-direction affords individuals an important option for maximum choice and control over their services, and can be an important tool for the expansion of integration community services." Does your State provide for self-direction?
* Identifies federal grants and enhanced Medicaid funding to support more balanced State long-term care services and to improve access to HCBS. Has your State applied for any of these?
* Notes that there were more than 200 Aging and Disability Resource Centers through out the country which are supposed to streamline access to long-term services and supports.
* Reminds your State that after 10/1/2010, each nursing facility though out the country must ask residents if they are "interested in learning about the possibility of returning to the community," and nursing facilities will be required to make referrals of individuals to ADRCs, CILs, AAAs.
* Notes that a person-centered hospital discharge planning grants have been awarded, and they are supposed to assist States in "developing hospital discharge planning structures and processes that will place greater emphasis in after-care plans, including community-base alternatives to institutional care."
WHAT ADVOCATES SHOULD DO:
Send the "Dear Medicaid" letter to your Governor, Lt. Gov, Speaker of the House, Senate and House Health and Human Services Chairpersons, head of all State agencies dealing with aging and disability programs;
Get with other disability and aging organizations in your state and go over all the points in the Dear Medicaid Director letter to see what your state has and has not availed themselves of;
Develop a strategy on how to get your state to move forward on the offers made in the Dear Medicaid Director letter;
Steve Gold, The Disability Odyssey continues
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