NCIL Now Pushing the Community First Choice Option in Healthcare Reform

NCIL continues to vigorously support the Community Choice Act (CCA) as a stand-alone bill.

For the last several months, NCIL has been working hard in Washington to ensure that the needs of people with disabilities are addressed in healthcare reform, while educating NCIL members about what is going on and how they can be involved.

Since the beginning of this process, NCIL has clearly stated its priorities in an effort to integrate the needs of the disability community into healthcare reform legislation, including language to end the institutional bias in Medicaid. It has been our unwavering goal to have the language of the CCA in the final reform bill, and our policy to pursue a compromise only if it became very clear that the CCA would not be a part of the reform legislation. Over the course of the last few weeks, that fact has been made very clear to disability advocates in Washington and throughout the nation. It is now time NCIL and the rest of the disability community pursue compromise in order to advance progress in our fight to end the institutional bias.

In previous communications to the membership, NCIL has mentioned a compromise known as the “state plan option”. NCIL now fully supports this plan and would like to take this opportunity to clearly explain it, so that our membership can get behind it too.

Proposal for a Community First Choice (CFC) Medicaid State Option for Inclusion in Health Care Reform

The core elements of the Community Choice Act (found in Section 101 of the bill) would be structured as an option for states to include in their Medicaid State Plans.  The Community First Choice (CFC) Option would provide individuals with disabilities who are eligible for nursing homes and other institutional settings with options to receive community-based services.  CFC would support the Olmstead decision by giving people the choice to leave facilities and institutions for their own homes and communities with appropriate, cost effective services and supports.  It would also help address state waiting lists for services by providing access to a community-based benefit within Medicaid.  The option would not allow caps on the number of individuals served, nor allow waiting lists for these services. A significant enhanced Federal Medical Assistance Percentages (FMAP) would be provided, depending on cost, to encourage states to select this option.

Summary of Core Provisions:

• Amend Medicaid to allow state Medicaid plan coverage of community-based attendant services and supports for certain Medicaid-eligible individuals.
  
• Services under this option would include services to assist individuals with activities of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related tasks through hands-on assistance, supervision, or cueing.  ADLs include eating, toileting, grooming, dressing, bathing, and transferring.  IADLs include meal planning and preparation; managing finances; shopping for food, clothing, and other essential items; performing essential household chores; communicating by phone and other media; and traveling around and participating in the community.  Health-related tasks are defined as those tasks that can be delegated or assigned by licensed health-care professionals under state law to be performed by an attendant.  Services also include assistance in learning the skills necessary for the individual to accomplish these tasks him/herself; back-up systems; and voluntary training on selection and management of attendants.  Certain expenditures would be excluded, including room and board; services provided under IDEA and the Rehabilitation Act; assistive technology devices and services; durable medical equipment; and home modifications. 
  
  
• Services must be provided in a home or community setting based on a written plan.
  
  
• Services must be made available statewide and must be provided in the most integrated setting appropriate for the individual. 
  
• Services must be provided regardless of age, disability, or type of services needed.
  
  
• States will establish and maintain a comprehensive, continuous quality assurance system, including development of requirements for service delivery models; quality assurance to maximize consumer independence and consumer control; and external monitoring; along with other critical state and federal responsibilities/requirements included in S. 683/H.R. 1670.
  
• Service delivery models must include consumer directed, agency-based, and other models, along with requirements to comply with all federal and state labor laws.
  
  
• States would be required to establish a Development and Implementation Council to work with the state in developing and implementing the state plan amendment necessary in order to provide the services.  The majority of Council members must be individuals with disabilities, elderly individuals, and representatives of such individuals, and must collaborate with, among others, providers and advocates.
  
  
• States would cooperate in reporting to Congress.
  
  
• CFC services would not affect the states’ ability to provide such services under other Medicaid provisions.
  
  
• Provision to collect data regarding number of people receiving services, dollars spent, and procedures for consumer control.

NCIL is not done supporting the Community Choice Act

NCIL is fully supporting the CFC as part of the healthcare reform legislation, but we stand firmly behind efforts to see that the Community Choice Act is passed as a stand-alone bill. We realize the limitations of the CFC, being only an option to states. We realize that all 50 state governments are different, and even if we are successful in getting the CFC included in a healthcare reform bill that is signed by the President, our brothers and sisters in institutions will not be freed in every state. The CFC will lay down a significant foundation, and will move our nation closer to equality, but the CFC will leave the decision to do the right thing up to states, and many states will fail their constituents. This is why we will continue to push for the federal government to mandate that states that offer the Medicaid program allow people the choice to get their long-term services and supports in their home or whatever setting they choose.

What do we do next?

There is a lot of work to do. The language of the Community First Choice option has been sent to the Congressional Budget Office (CBO) for a cost estimate (known as a “Score”). NCIL has been actively working with the House, the Senate and the Obama Administration to get their support, but their support is limited until the cost of the legislation is known. NCIL is putting together another alert specifically about the need for people with disabilities to support healthcare reform, including the CFC. We plan to have that out next week, and encourage all members to get and stay involved in this process! Watch for information to come soon!

For Additional Questions:

If you have questions about the Community First Choice option, contact NCIL Policy Analyst, Jason Beloungy at 202-207-0334 (toll-free: 1-877-525-3400) ext. 1008. Jason can also be reached by e-mail at jason@ncil.org.