Community Integration of People with Disabilities: Can Olmstead Protect Against Retrenchment?

Crossley, Mary

doi:10.3390/laws6040022

Cited by 8 publications

(3 citation statements)

References 5 publications

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“…17. See Mary Crossley (2017) for a discussion about how public protests by people with disabilities may have cemented the idea that community integration is a civil right in the public's mind. 18.…”

Section: Discussionmentioning

confidence: 99%

Unfinished business: deinstitutionalization and Medicaid policy

Knight

2020

Politics, Groups, and Identities

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Deinstitutionalization heavily implicates Medicaid policy since waivers for home and community-based services have provided the means to realize the community integration mandate of the Americans with Disabilities Act (1990) and the Supreme Court's Olmstead (1999) decision. Despite tremendous advances toward community living, several components of Medicaid's design and implementation continue to create barriers for people with disabilities who want to live independently in the community. This article draws on knowledge produced from the lived experience of disability to identify five issues with Medicaid policy that prevent it from living up to the promise of the ADA and the Olmstead ruling: (1) institutional bias, (2) federalist structure, (3) work disincentives, (4) red tape and administrative burden, and (5) low reimbursement rates for personal care attendants. The wider implication of the analysis is that deinstitutionalization involves more simply closing institutions. Active measures to promote community integration are also vital.

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Section: Discussionmentioning

confidence: 99%

Unfinished business: deinstitutionalization and Medicaid policy

Knight

2020

Politics, Groups, and Identities

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“…. In Medicaid, integration is optional, but segregation is mandatory” (Crossley, 2017, p. 5). As a result, while an individual may prefer to age at home, there may not be availability of such services.…”

Section: Discussionmentioning

confidence: 99%

Aging in Place: A National Analysis of Home- and Community-Based Medicaid Services for Older Adults

Friedman

Caldwell

Kennedy

et al. 2018

Journal of Disability Policy Studies

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The number of Americans needing long-term services and supports (LTSS) is projected to more than double in the coming decades, from 12 to 27 million by 2050, largely due to an aging baby boomer population and the prevalence of disability increasing with age (The SCAN Foundation, 2012). With longer life spans, higher rates of chronic conditions, fewer family caregivers, and increasingly limited federal, state, and family resources, paying for LTSS will become an even greater challenge for American families and our country (Federal Commission on Long-Term Care, 2013). Medicaid is currently the primary funder of LTSS in the United States, financing approximately 62% of all LTSS costs (National Health Policy Forum, 2014). However, the Medicaid program requires older adults and people with disabilities to impoverish themselves. Moreover, there remains a long-standing institutional bias within the Medicaid program, where services in nursing facilities are mandatory while home-and community-based services (HCBS) are mostly optional for states to cover. For these reasons, the aim of this study was to explore Medicaid HCBS 1915(c) waivers for older adults. Significant progress has been made over the past two decades in shifting the balance from institutional services to HCBS within states. In 1995, only approximately 18% of national Medicaid LTSS spending was devoted to HCBS (Eiken, Srel, Burwell, & Woodward, 2017). By 2015 (the most recent year for which data is available), HCBS accounted for 55% of total national Medicaid LTSS spending. However, despite overall national progress, significant variations remain across states and different populations receiving services. For example, while HCBS accounted for 75% of total Medicaid LTSS spending for individuals with intellectual and developmental disabilities (IDDs), HCBS only accounted for 44% of total Medicaid LTSS spending for older individuals and individuals with physical disabilities. Seven states spend 20% or less of their LTSS expenditures for older adults and individuals with physical disabilities on HCBS. States have numerous authorities and a great deal of flexibility in how they design Medicaid HCBS program. Three primary authorities that states have used are as follows: (a) mandatory home health services state plan benefit, (b) optional state plan amendments (i.e., personal care 788889D PSXXX10.

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“…23 Moreover, political, financial, and logistical factors impede continued progress in advancing the community integration of Medicaid recipients with disabilities. Recent proposals to fundamentally restructure Medicaid and slash its federal funding pose a serious threat to states' support of HCBS, 24 and the nursing home lobby has a vested interest in preventing further shifting of Medicaid spending away from institutional care. On a personal level, however, the immediate challenges for a Medicaid recipient seeking to transition out of (or to avoid going into) a nursing home include finding a place to live that is both affordable and accessible.…”

Section: Coverage Of Home and Community-based Servicesmentioning

confidence: 99%