Unfinished business: deinstitutionalization and Medicaid policy

Abstract

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.

Improving Older Adults’ Health by Reducing Administrative Burden

“…31 Waiting lists create their own array of burdens, especially high compliance costs, including the amount of time people have to wait to receive services. 58 A study of a five-county Area Agency on Aging in Florida, focuses on coordinating access to long-term care, demonstrates these burdens. 59 Importantly, area agencies are funded by the Older Americans Act, with the purpose of helping older adults navigate the fragmented long-term care system.…”

“…Waiting lists create their own array of burdens, especially high compliance costs, including the amount of time people have to wait to receive services 58 . A study of a five‐county Area Agency on Aging in Florida, focuses on coordinating access to long‐term care, demonstrates these burdens 59 .…”