... seniors rally for alternatives in the setting for their care
Note: Among hundreds who rallied in support of the Equal Choice bill on Thursday, April 5, were 22 from Melrose who traveled by bus from the Milano Senior Center. The following information on the legislation was provided by Rep. Mike Festa as part of an invitation to the rally in Nurses Hall on behalf of the bill sponsored by the Mass. Home Care & Mass. Senior Action organization.
The "Equal Choice Bill" House Bill #1589 simply says that if a disabled person is likely to require the level of care provided by the Medicaid program in a nursing home, they should be given an "equal choice" of a setting that is not biased towards institutional care. This bill will allow disabled seniors a choice of receiving the same amount of care at home as they would receive in a nursing home.
AN ACT REGARDING EQUAL CHOICE OF LONG TERM CARE SETTINGS.
Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows:
SECTION 1. Chapter one hundred and eighteen E of the general laws is hereby further amended by adding after section 9C the following new section:
Section 9D. An individual age sixty or over who is entitled to medical assistance under the state plan either in the community or in an institution, and who is determined to be likely to require the level of care provided in a nursing facility, shall be permitted to choose to receive home or community based care rather than nursing facility services in the most integrated setting appropriate to the needs of such individual, provided that such individual shall be allowed to receive up to the same amount or greater service expenditures per month for home or community based services as he or she would have received under the state plan in a nursing facility, provided that on average the per capita expenditures estimated by the commonwealth in any fiscal year for home or community based services provided with respect to such individuals under this section shall not exceed 100 percent nor be less than 50 percent of the average per capita expenditures that the commonwealth reasonably estimates would have been made under the state plan in that fiscal year for expenditures that such individuals would have received in a nursing facility.
The Equal Choice in Long Term Care Settings Bill
Background: In June of 1999, the US Supreme Court ruled in Olmstead v L.C. that the unjustified segregation and institutionalization of people with disabilities constitutes unlawful discrimination in violation of the Americans with Disabilities Act. The Court said that disabled individuals should be served in the most integrated setting. After the ruling, the federal government indicated that it would work with states to increase community based alternatives to institutional care. The Olmstead case applies to all individuals with disabilities protected from discrimination under Title II of the ADA. The ADA applies to all state programs, not just Medicaid.
The ADA defines "disability" as "a physical or mental impairment that substantially limits one or more of an individual's major life activities." Such activities include: caring for oneself, walking, seeing, hearing, working, etc. The disabled person must meet the eligibility requirements for receipt of services in any state's programs, activities, or services. Disability is not related to age. But if an elder has a physical or mental impairment that substantially limits one or more of his or her major life activities, he or she would be protected under the ADA.
The lack of necessary community based services has been a major barrier to the integration of people with disabilities. The Olmstead case has made it clear that discrimination against the disabled is a violation of their civil rights. As Secretary Donna Shalala wrote to all Governors in January of 2000, the mutual goal of state and federal governments is "integrating individuals with disabilities into the social mainstream, promoting equality of opportunity and maximizing individual choice."
In Massachusetts, thousands of elderly disabled persons are being denied an opportunity to live in the most integrated setting. In choosing between institutional vs. community care, the disabled have not been presented with an equal opportunity. Historically, the Commonwealth has spent most of its long term care dollars on institutional care. In 1998, for example, 71% of Medicaid dollars were spent on nursing home care:
According to the Massachusetts Medicaid office, in FY 97, the Commonwealth spent $969.5 million on Medicaid institutional care for the "dually eligible" population, compared to $42.7 million for community long term care for the same population. We spent 23 times as much on institutional care as on the community.
We had 49,628 nursing home beds in Massachusetts ini 1998, and roughly 36,000 people in the home care program. Between 1991 and 1997, Massachusetts had a 42% increase in nursing home beds, and a 34% increase in nursing home residents. By contrast, home care services fell from 45,000 elders a month in 1988, to 36,000 in 1998.
There were only 3,714 elders in the home and community based services waiver in 1998, with total expenditures of only $3.8 million. The mentally retarded fared much better when it came to community based care. There were 9,068 retarded enrollees in the HCBS waiver, receiving a total of $282 million in state funding. Per capita spending on MR waiver clients was 26 times greater than spending on the elderly.
The Equal Choice Bill
The premise behind the "equal choice" bill is that disabled people are being discriminated against, and denied their civil right to avoid unnecessary institutionalization, in part because of the bias in state programs towards institutional care. Elders should be afforded an equal choice between care in the community, or care in an institution. As the U.S. Dept of Health & Human Services has pointed out: "key programs, such as Medicaid, may sometimes present difficulties for people with disabilities to have access to quality care in the community."
The Equal Choice bill says that if a disabled person is likely to require the level of care provided by the Medicaid program in a nursing home, they should be given an "equal choice" of setting that is not biased towards institutional care. The consumer would be given a choice of institutional care or community care, and the "dollars would follow the client" because the worth of that care would be the same under either setting. The total cost of services to such a disabled individual could not exceed the cost of care had they been placed in an institution, and the aggregate cost of all individuals served in the community under this bill also would not exceed 100% of what the Commonwealth would have spent to place them in institutions under the state Medicaid plan.
To eliminate discrimination, and end unnecessary isolation, the Commonwealth would allocate funds with an equal hand, and provide disabled persons with access to quality care in the community, or, if necessary, in an institution.
Finally, the equal choice bill establishes a "floor" on the average per capita expenditures for these disabled elders, set at 50% of the cost of nursing home care, which sets the lower limit for service availability under this bill. The floor ensures that elders will receive sufficient care to be maintained safely in the community. Currently, the average cost per client expenditure is only $224 per month-an average which is both inadequate and punitive at the same time.
If any seniors want more information they can contact Rep. Festa in the State House at 617)-722-2210.
Rep. Mike Festa notice on filing this bill was published in the Melrose Mirror on January 5, 2001.
April 6, 2001