Medicaid Community Attendant Services and Supports Act

S. 971 and HR 2032

MiCASSA gives people real choice in long term services. It creates an alternative Medicaid service called Community Attendant Services and Supports. MiCASSA allows individuals eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded (ICF-MR) the choice to use these dollars for "Community Attendant Services and Supports." THE MONEY FOLLOWS THE INDIVIDUAL!

What does this bill do?

Provides community attendant services and supports which range from assisting with activities of daily living (eating, toileting, grooming, dressing, bathing, transferring) instrumental activities of daily living (meal planning and preparation, managing finances, shopping, household chores, phoning, participating in the community), and health-related functions.

Includes hands-on assistance, supervision and/or cueing, as well as help to learn, keep and enhance skills to accomplish such activities.

Requires services be provided in THE MOST INTEGRATED SETTING appropriate to the needs of the individual.

Provides Community Attendant Services and Supports that are:

• based on an assessment of functional need;
• provided in home or community settings like -- school, work, recreation or religious facility;
• selected, managed and controlled by the consumer of the services;
• supplemented with backup and emergency attendant services;
• furnished according to a service plan agreed to by the consumer;
  and
• include voluntary training on selecting, managing and dismissing attendants.

MiCASSA Allows consumers to choose among various service delivery models including vouchers, direct cash payments, fiscal agents and agency providers, all of which are required to be consumer controlled.

For consumers who are not able to direct their own care independently, MiCASSA allows for "individual's representative" to be authorized by the consumer to assist. A representative might be a friend, family member, guardian, or advocate.

MiCASSA Allows health-related functions or tasks to be assigned to, delegated to, or performed by unlicensed personal attendants, according to state laws.

MiCASSA Covers individuals' transition costs from a nursing facility or ICF-MR to a home setting, for example: rent and utility deposits, bedding, basic kitchen supplies and other necessities required for the transition.

MiCASSA Serves individuals with incomes above the current institutional income limitation -- if a state chooses to waive this limitation to enhance the potential for employment.

MiCASSA Provides for quality assurance programs which promote consumer control and satisfaction.

MiCASSA Allows states to limit the aggregate amount spent on long term care in a year to that amount the state would have spent on institutional services for such eligible individuals in the year.

MiCASSA Provides a maintenance of effort requirement so that states can not diminish more enriched programs already being provided.

MiCASSA also provides grants for Real Choice Systems Change Initiatives to help the states transition from current institutionally dominated service systems to ones more focused on community services and supports.

Each state will create a Consumer Task Force to develop a plan for transitioning services into a more community oriented system. A majority of the members must be people with disabilities or their representatives.

MiCASSA Talking Points

Our long term care service system must change.

The current system was created over thirty years ago and is funded by Medicare and Medicaid dollars. These are medical dollars which were not originally conceived to meet people's long term care needs. We must think out of the box to a new system that empowers people and allows REAL choices.

The money should follow the individual not the facility or provider. A national long term care service policy should not favor any one setting over the other. It should be neutral, and let the users choose where services will be delivered.

The current system is not neutral. Institutional services command 49.5 billion dollars of Medicaid long term care while only 18.2 billion remains to pay for all the community services. The Current system is expensive and methods to meet the needs of people in the most cost-effective way must be explored.

Community services are less expensive, on average and are much more desirable than institutional services.

Overwhelmingly people prefer community services to stay in their own home. The federal government needs to work in partnership with the states to create flexible delivery systems that gives people with disabilities REAL choice.

Change causes fear of the unknown. There are some long time providers of services and families who believe REAL choice would threaten what they have. We cannot continue the system as it is today. It is expensive, fragmented, over medicalized and not liked by almost everyone.

There's No Place Like Home!