Community First Choice Option
It didn’t start out as part of the new Health Care Reform Bill, but for years ADAPT has worked to end the Institutional bias in America’s Medicaid system. ADAPT activists across the nation are celebrating the Community First Choice Option that is part of the Health Care Reform Bill that Congress passed Sunday March 21.
Twenty years ago with the signing of the Americans with Disabilities Act, ADAPT activists began to work to end the Medicaid bias that supported facilities and institutions but failed to help someone to stay in their own home or live and work in the community. Early on ADAPT called to redirect 25 percent of Medicaid funding away from institutions for support at home. In 1996, when 90% of Medicaid was funneled into expensive nursing homes, ADAPT engineered Newt Gingrich, then the House Majority Leader to introduce the Community Attendant Services Act, CASA.
A few U.S. states understood the logic and cost savings of the idea and begin to offer more home and community based services through state waivers of the federal Medicaid requirements. Rather than channeling all the federal funding into the for-profit nursing home industry, some progressive states “waived” the institutional requirement and provided home and community based services that allowed people to stay at home at a much lower cost to the state.
ADAPT worked for national legislation and Sen. Tom Harkin introduced MiCASSA, the Medicaid Community Services and Supports Act, to finally give Americans a real choice to live in their own home. While many states inched into providing more waivers, the nursing home industry blocked the national legislation to hang on to as much of the public funding as possible. With a nursing home in every county in the US, the institutions, money and old-boy lobbyists were able to prevent Americans from having choices in long-term Medicaid.
But in 2003 following ADAPT’s Free Our People March from Philadelphia to Washington DC, the Queen Mary began to turn. States were offering waivers for about 30% of long-term Medicaid care, and state budgets were reflecting the savings. Congress adopted “Money Follows the Person” legislation in 2006 that took the funding section of MiCASSA and gave incentives for states to provide home and community options to expensive institutions.
ADAPT’s work is not done. Federal law that requires equality is just not enforced, mostly the 1999 Supreme Court Olmstead decision. This ruling reinforced the fact that inappropriate institutionalization was discrimination; a type of discrimination unique to people with disabilities.
ADAPT has begun the Defending Our Freedom Campaign to make the federal government responsible for enforcing our rights. The Defending Our Freedom also asks grassroots people with disabilities to document their struggles to secure home and community based services.