Senator Harkin — Setting Our People Free

Circa 2005


Dear ABILITY Readers,

This year celebrates the 15th anniversary of the Americans with Disabilities Act (ADA). Authoring the ADA and shepherding its passage was one of the proudest achievements of my career in Congress. When we passed the ADA, we set four great national goals for individuals with disabilities: equal opportunity, independent living, full participation and economic self-sufficiency. With this landmark legislation, America committed itself to the principle that disability does not limit a person’s right to participate in the cultural, economic, educational, political and social mainstream.

Today, the positive impacts of the ADA are all around us. Many restaurants have visual displays allowing people who are deaf to place their orders independently. Many banks have talking ATMs to assist individuals who are blind. Service animals are welcome in restaurants and shops. Many more streets and buildings are accessible. And just as important, people’s attitudes are changing in positive ways.

During the past 15 years, America has made enormous strides in breaking down barriers for people with disabilities. But we still have a long way to go before we have truly opened the doors of opportunity to everyone. The current Medicaid system is unacceptably biased in favor of institutional care. Two-thirds of Medicaid longterm care dollars are spent on institutional services, with only one-third going to community-based care. It’s time to rebalance the system.

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To that end, I have re-introduced two bills in the new Congress that I believe will make a tremendous difference.

The first bill is called the Medicaid Community-Based Attendant Services and Supports Act (MiCASSA).

MiCASSA would give people who are currently eligible for nursing home or institutional services equal access to the services and supports they would need to live instead in the community. The legislation would also provide funding to states to help them reform their longterm care systems and increase the provision of homeand community-based services.

The second bill is the Money Follows the Person Act.

This legislation would create a pilot program in which the Medicaid money paid by states and the federal government would follow the person with a disability from an institution into the community. The Act would provide 100 percent reimbursement for the community services that an individual needs during the first year after he or she moves out of a nursing home or similar facility. After the first year, the individual would remain in the community, and states would receive their regular Medicaid match for their services.

These bills would allow people with disabilities to have choices that many take for granted: to live with family and friends, not with strangers, and to live in a neighborhood, not a nursing home or institution. Federal Medicaid policy should facilitate, not frustrate, our belief that Americans with disabilities should have an equal opportunity to contribute to our communities and participate in our society as full citizens.

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We all know it takes money to pay for community services. But I think of my nephew Kelly, who acquired paraplegia while serving in the military. The Veterans Administration pays for his attendant services so he is able to get up in the morning, go to work, operate his small business, pay his taxes and be a fully contributing member of our society.

That’s what every person with a disability wants. And the costs would be largely offset by the benefit of having people with disabilities who are employed, paying taxes and contributing to the economy.

We are building support for these two bills from members on both sides of the aisle. But let’s not kid ourselves. This is by no means a done deal. We’re going to have to fight for these new laws. But with appropriate community-based services and supports, we can continue to transform the lives of people with disabilities.

by Senator Tom Harkin

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