Harkin Testimony at MiCASSA/FMP Hearing
The testimonies of panelists at Wednesday's hearing are
available online in pdf format:
http://finance.senate.gov/sitepages/hearing040704.htm
Because of his longstanding support for MiCASSA and disability issues
generally, it seems appropriate to feature Senator Tom Harkin's testimony,
provided in text below.
Jonathan Young
JFA Moderator, AAPD
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Testimony of Senator Tom Harkin (D-IA)
On the Need to Increase Access to Home and Community-Based Services for People
with Disabilities
I want to begin by thanking the Chairman and the Ranking Member for holding
this hearing. Senator Smith and Senator Specter joined me in requesting this
hearing, and I am very grateful to the committee for taking up this important
issue. We are very fortunate to have the leadership of my friends from Iowa
and Montana on this important committee and I thank them for their work on
behalf of older Americans, people with disabilities, and those with low
incomes. I'd also like to recognize Senators Specter and Smith for their
ongoing leadership on the issue before the committee today: how do we give
older Americans and people with disabilities greater choices by expanding
access to community based services.
When we passed the Americans with Disabilities Act almost 14 years ago, we
said that our nation's great goals regarding individuals with disabilities
were to ensure equality of opportunity, full participation, independent
living, and economic self-sufficiency for such individuals. And when we passed
ADA, I was under no illusions. I knew then that Medicaid was going to be the
next challenge, because some of the Medicaid rules prevent us from reaching
all of these goals. It is hard to be full participants and economically
self-sufficient if your only choice is to live in a nursing home or
institution.
Since 1990, I have been working to correct the institutional bias in our
Medicaid program. And I am hopeful that this hearing is the beginning of a
quick legislative process to finally address this serious problem. According
to the Congressional Research Service, national data indicates that we are
spending 70 percent of our Medicaid long-term care dollars on institutional
and nursing home care, and only 30 percent on community-based services. The
Chairman will be interested to know that in Iowa, the latest figures are even
worse: 81 percent of our state's Medicaid funds are going to institutional and
nursing home care, and only 19 percent is paying for services in the
community.
This is wrong - and it's time to rebalance the system. That's why I have
introduced two bills that would make a tremendous difference. I hope the
committee will look carefully at these bills and move quickly to mark up
legislation and move it to the floor.
The first bill is called MICASSA for short. That stands for the Medicaid
Community Based Attendant Services and Supports Act. MICASSA has a simple aim.
It would level the playing field by requiring states to cover community
services under their Medicaid programs. Right now, states are required to
provide nursing home care, but there is no similar requirement for community
attendant services and supports. Why should this be? MICASSA would change
that, and it's high time.
The second bill, the Money Follows the Person Act, also has a simple aim. It
says: Provide resources so people with disabilities and older Americans can
make their own choice among service options. The Money Follows the Person Act
would provide 100 percent federal funding for the first year of
community-based services for people who move out of a nursing home or
institution. After that first year, the individual would remain in the
community, and states would receive their regular Medicaid match for their
services. States would be allowed to expand their waiver programs, offer new
waivers, or add community based services to their Medicaid plans. The Money
Follows the Person Act would provide $350 million a year for a total of $1.75
billion over 5 years. And that would be a major contribution to expanding
community services.
It is important to note that these two bills are bipartisan initiatives, as
was the ADA and other major civil rights legislation for individuals with
disabilities. Senator Specter has joined me in co-sponsoring both of these
bills. Senator Smith is the lead Republican co-sponsor of the Money Follows
the Person bill.
In addition, the Money Follows the Person program is a critical piece of the
President's New Freedom Initiative. We have support from President Bush and
from both sides of the aisle for moving forward to expand access to community
based services. That's why I am so hopeful that we can move forward quickly to
put an end to needless institutionalization.
Let me give you just one example of how these two bills can transform the
lives and living conditions of people with disabilities. I was in Iowa just a
few weeks ago to talk about these initiatives. And I had the privilege to be
on a panel with a young man named Joel Justin. Joel is a 36- year-old man who
experienced a brain injury. He is currently forced to live in a nursing
facility in Waterloo -- more than two hours away from his family and friends
-- because there is no funding to support him in his own community. He spends
most of his time watching TV, but he would prefer to be working at a job. He
also wants to live in his own apartment because he is tired of the
restrictions in the facility. He says that he wants - and I quote -- "freedom
to do whatever I want and to come and go as I please."
The Independent Living Centers, and Protection and Advocacy in Iowa, tell me
that there are many other people in similar situations. And I know that Iowa
is not unique in this respect. We need to change federal law so that Joel and
thousands like him can realize their hopes and dreams, and become fully
participating, economically self- sufficient citizens.
This is the right thing to do, but it is also the smart thing to do. States
can save money by giving individuals greater choices. For example, when
Secretary Tommy Thompson was governor of Wisconsin, the state implemented a
Community Options Program to expand access to community based services. In a
2001 report to the legislature, the Department of Health and Family Services
noted that, using the most conservative estimate, the total public spending of
individuals served in the community was $64 million less than if they had
resided in nursing homes for the same length of time.
While we can put a dollar figure on cost savings, there is a much greater cost
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.
Current Medicaid policy is preventing that vision from being a reality for
millions of older Americans and people with disabilities. They have waited 14
years since the passage of ADA for this injustice to end, and they should not
have to wait any longer.
I thank the committee for the opportunity to be here today. I know that you
will be hearing from many wonderful witnesses, including two remarkable Iowans
- Ray Gerke and Di Findley. I've had the opportunity to read their testimony
in advance, and if all 100 Senators could hear what they have to say, I think
we'd have legislation passed within weeks.
Again, I want to thank the Chair and Ranking member for inviting me to
testify. I stand ready to help in any way I can to move this process forward
and get legislation passed and signed into law.
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