Senator Harkin’s Letter — Community-Based Services

Circa 2007


Dear ABILITY Readers,

As many of you know, one of my key priorities in the Senate has been to give older Americans and people with disabilities greater choices by expanding access to community-based services.

I want to share with you a recent victory on that front. I was pleased to learn that Iowa will be the first state to receive approval from the U.S. Department of Health and Human Services (HHS) to add home and community-based services as a permanent feature of its Medicaid plan. This means my home state will no longer need to reapply each year for waivers in order to provide cost-effective services to Medicaid recipients.

In the official announcement, HHS Secretary Mike Leavitt said, “Stopping the burdensome cycle of continually having to request federal government permission to offer a benefit that is good for people and programs will be a huge relief for states and beneficiaries.”

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Previously, such waivers were limited to three or five years, requiring states to ask for renewals. The waiver process can take months to complete.

HHS expects other states to follow Iowa’s lead in taking advantage of the new provision, which grants new freedom to state Medicaid programs and the people who depend on them.

This announcement is a huge step in the right direction, and I am proud that Iowa will become a model for the nation in providing equal opportunity, full participation, independent living and economic self-sufficiency for all individuals.

Since the day we passed the Americans with Disabilities Act (ADA), I have worked to correct the institutional bias in our Medicaid program and to put an end to needless institutionalization. It is difficult for Medicaid recipients to participate fully in our society, and be economically self-sufficient, when their only choice is to live in a nursing home or institution.

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Giving states the flexibility to allow people with disabilities and older Americans to make their own choices among service options promotes independence. It is also cost effective and consistent with the Supreme Court’s 1999 decision in Olmstead, which affirmed the right of individuals with disabilities to live within their community rather than be forced into institutions. While we can put a dollar figure on the cost savings, more is at stake here: The cost in lost opportunities and lost dreams. When we passed the ADA, Congress created a vision of opportunity, equality and independence. I am happy to report that current Medicaid policy is falling in step with that vision, and making it a reality for millions of older Americans and people with disabilities.


Senator Tom Harkin

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