RESEARCH INFORMATION ON INDEPENDENT LIVING
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Volume 2, Issue 11

MiCASSA

ADAPT, a disability organization advocating for the U.S. government to provide personal assistance, drafted a bill that would change the U.S. long-term care system and has tried to have it passed as a law.

“ADAPT’s goal is to reform the institutionally-biased, Medicaid long-term care system by giving people with disabilities a real choice to live in the community. Nobody should be forced into a nursing home in the 21st century because of a lack of options,” Bob Kafka, ADAPT of Texas, said.

Known informally as MiCASSA, the Medicaid Community Attendant Services and Supports Act (S 971 and HR 2032), sets up a national program of community-based attendant services and supports for people with disabilities, regardless of age or disability type.

This legislation changes Title XIX of the Social Security Act (Medicaid) by letting people eligible for Nursing Facility Services or Intermediate Care Facility Services for the Mentally Retarded choose to get services in their community instead of from a nursing home or other institution.

The bill is designed so that if a person is eligible for nursing home care, then the same person can receive care at home. The funds also cover payment for things needed when coming out of nursing homes such as rent deposit, house supplies, and other housekeeping needs. If a person isn’t capable of managing an assistant, then a representative such as a parent or other authorized person can help with management.

MiCASSA isn’t a one-size-fits all system. “The money follows the individual” instead of a facility receiving money to offer care. Some say this could set off the “woodwork” effect and cause people who shunned institutional care to claim personal assistance funds. Supporters say MiCASSA-type programs in Washington, Oregon, Wisconsin, and Kansas show this isn’t likely to happen.

Specifically, MiCASSA:

• Includes hands-on assistance to accomplish daily activities.
• Requires that services be provided in the most integrated setting possible.
• Provides services based on need, rather than diagnosis or age.
• Has backup and emergency attendant services.
• Lets service users select, manage, and control services.
• Allows service users to choose from vouchers, cash payments, fiscal agents, and agency providers for payment options.
• Allows people who are not licensed by state laws to perform services.
• Covers expenses that occur when someone moves out of a nursing home such as rent deposits, bedding, etc.
• Establishes quality check programs for services provided.\
• Is available to people who have incomes above the current institutional income limitation if the state chooses to allow this to increases the person’s employment options.
• Allows matches of up to 90% federal funds for people whose costs exceed 150% of average nursing home costs.
  
  People using services in their home could save the government money. In 1998, Medicaid spent $44 billion on nursing homes, according to the Health Care Financing Administration and $14 billion on home- and community-based services. According to the Disability Statistics Center in San Francisco, Medicaid spends $23,225 for services in a nursing home per person and $7,276 for services provided in a person’s home.