New
Freedom Initiative
NAMI E-News January 8, 2002 Vol. 02-43
White House
Issues Report on “New Freedom Initiative” and Implementation of the U.S.
Supreme Court’s Olmstead Decision
On December 21, the White House released its
first progress report on an Executive Order signed by President Bush in June 2001
to promote community-based alternatives for people with severe disabilities,
including children and adults with severe mental illnesses. Executive Order
13217 is the centerpiece of the Bush Administration’s “New Freedom
Initiative” and efforts to help states meet their obligation to promote
community integration for people with disabilities under the Supreme Court’s
1999 L.C. v. Olmstead case.
This progress report details steps already taken -
as well as proposed actions - by federal agencies to implement both Executive
Order 13217 and the Olmstead case. A number of these actions and recommendations
are of concern to individuals with severe mental illnesses and their families in
the areas of Medicaid funding of community-based services, housing, family
support, employment, income supports and legal rights.
Among the key actions and
recommendations in the Bush Administration’s new report are:
- Medicaid
funded services for children - This report directs the Centers for Medicare and
Medicaid Services (CMS) to develop a new demonstration program for home and
community-based services as an alternative to Medicaid-funded psychiatric
residential treatment centers for children and adolescents. This new
demonstration program will allow states to set up community-based alternatives
for children and adolescents who would otherwise be served in residential
treatment centers.
This new program is the first step in reversing longstanding
federal policy that has excluded children and adolescents with severe mental
illnesses from home and community-based waiver programs that already serve
children and adolescents with mental retardation and other disabilities. Current
requirements for “budget neutrality” for these Medicaid waivers (known as
1915(c) demonstrations) have severely restricted services for children and
adolescents with mental illness.
It is important to note that the Bush
Administration’s new report does not address the current IMD (Institution for
Mental Disease) Exclusion in federal Medicaid law that bars coverage of all
services to adults ages 22 to 64, most psychiatric hospitals, and many
community-based residential programs. The IMD Exclusion has served to isolate
non-elderly adults with severe mental illnesses from all other Medicaid-eligible
populations for inequitable coverage of services. The IMD Exclusion has also
served to severely restrict state use of Home and Community-Based waivers under
Medicaid to serve adults with severe mental illnesses. This has occurred because
states have no existing pool of Medicaid expenditures from which to draw on to
fund waivers that expand community-based services.
The New Freedom Initiative
and Executive Order 13217 served as an important opportunity for the Bush
Administration to authorize and promote state experimentation to set aside the
severe and discriminatory constraints of the IMD exclusion to promote access to
treatment and supportive services targeted adults with severe mental illnesses.
Despite this setback, NAMI will continue to support both the legislative repeal
of the IMD Exclusion and administrative efforts to state flexibility.
- Discharge Planning
- HHS will review current Medicare and Medicaid discharge
planning policies to ensure that institutions and hospitals participating in
these programs provide more effective discharge planning for adequate and
appropriate community-based care. NAMI has advocated similar action on the part
of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO),
the non-governmental body that accredits most public and private general and
psychiatric hospitals.
- Veterans - The Department of Veterans’ Affairs is
directed to increase the availability of mental illness treatment services at
its community-based outpatient clinics. The report notes that many VA clinics do
not offer basic mental health services. This report will be require all VA
outpatient clinics to submit plans for the provision of such services by the end
of FY 2002.
- Housing - The Bush Administration’s new report will require the
Department of Housing and Urban Development (HUD) to provide technical
assistance to Public Housing Authorities (PHAs) to expand utilization of Section
8 rental vouchers for people with disabilities - including non-elderly adults
with severe mental illnesses. Since 1996, Congress has directed more than $250
million in funding for Section 8 tenant-based rental assistance targeted solely
to people with disabilities.
Unfortunately, HUD has been slow to spend these
funds as a result of the reluctance of many PHAs to apply and the difficulty
among eligible people with disabilities in finding housing once they receive a
voucher (i.e., lack of affordable rental housing and discrimination on the part
of landlords). This guidance is intended to help address these problems. HUD
will also be developing guidance for states and localities receiving Community
Development Block Grant (CDBG) on their obligations under the Olmstead decision.
- Employment - the report directs the Labor Department to work with other
federal agencies, including SAMHSA and Rehabilitation Services Administration,
to promote full inclusion of people with psychiatric disabilities into workforce
investment programs (DoL’s mainstream job training programs). The Labor
Department will also be developing a new grant program to the states to ensure
that employment is integrated in the state Olmstead planning - including the
involvement of state and local “Workforce Investment Boards” that control
billions of federal job training funds. The report maintains the commitment on
the part of the Bush Administration to full and swift implementation of the 1999
Ticket to Work and Work Incentives Improvement Act (TWWIIA).
- Family Support -
The report directs HHS to develop a legislative proposal for a 10-year
demonstration program to provide relief for parents of children with severe
disabilities who provide care in the home. This demonstration would allow states
to provide respite care tailored to the needs of individual families and
generate data about the cost and utilization of such services. Unfortunately,
this new program appears to completely exclude parents who care for adult
children with severe disabilities (including mental illnesses) in the home - a
key concern for NAMI.
This new Bush Administration’s report does not contain
an important recommendation in the President’s New Freedom Initiative - a
national commission on services for children and adults with severe mental
illnesses. According to White House officials contacted by NAMI, this commission
is expected to officially appointed in the next few weeks and will focus its
attention on community-based public sector services for individuals with severe
mental illnesses.
The full text of the report (entitled "Delivering on the
Promise: Preliminary Report of Federal Agencies' Actions to Eliminate Barriers
and Promote Community Integration") can be viewed at: www.hhs.gov/newfreedom/presidentrpt.hmtl.
The report is also linked to the HHS New Freedom Initiative page at: www.hhs.gov/newfreedom.
NAMI comments on Executive Order 13217 can be viewed at: http://www.nami.org/update/20010828.htm
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