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The Medicaid Community-Based

Attendant Services and Supports Act (MiCASSA)

S. 971 and H.R. 2032

VOR opposes passage of S. 971 and H.R. 2032, the Medicaid Community-Based Services and Supports Act (MiCASSA).

Good Intentions

MiCASSA proposes a mandatory Medicaid entitlement for community-based personal attendant care services. As proposed, this entitlement would be phased in over a period of five years and during that time early-coverage Sates would be rewarded with enhanced federal Medicaid matching dollars. State responsibilities include the develpment of a quality assurance program within noted federal guidelines and continued maintenance of funding for Intermediate Care Facilities for the Mentally Retarded (ICFs/MR) at pre-MiCASSA levels -- a freeze on funds for ICFs/MR.

Impact

VOR is concerned that the actual effect of MiCASSA will be the elimination on necessary services for citizens with severe and profound mental retardation, due to the expected cost of implementing the MiCASSA entitlement.

To be eligible for MiCASSA, an individual must be eligible for medical assistance and either nursing facility care or services in an ICF/MR. These eligibility requirements are exactly the same as in a 1997 version of MiCASSA (H.R. 2020). At that time, the Congressional Budget Office (CBO) estimated that 8 million people may be eligible. Assuming that only 2 million would actually request the benefit, CBO estimated an annual federal cost of $10-20 billion.

For States to accommodate this increase in mandatory Medicaid expenditures, funding for  optional Medicaid programs, such as the Home and Community-Based Services (HCBS) waiver and ICFs/MR, will be cut. Quality and availability will suffer. The maintenance of effort provision, described above, will not help ensure adequate funding and quality of care as the years pass and the cost of care rises, but funding remains frozen at pre-MiCASSA levels.

How to Achieve Equity

MiCASSA would develop a system in which mandatory funding for personal attendant care services would risk optional funding for other needed programs for people with mental retardation and other disabilities. A more equitable solution is to consider how to make more available personal attendant care services already available through the optional Medicaid Home and Community-Based waiver program. Through a coordinated approach, Congress and the Administration should consider initiatives that address expanded availability, personal attendant care certification, wages and training, and general quality of supports. This sort of effort -- which allows State and federal policymakers to consider the expansion of all optional Medicaid services in a way that reflects service needs rather than arbitrary and potentially harmful mandates -- is consistent with spirit and letter of the federal agencies' 2002 reports to the President, "Delivering on the Promise."

Good intentions are not enough to mitigate concerns about the expected real impact of S.971 and H.R. 2032. Those who stand to be hurt by these good intentions are the most fragile of our nation's citizens: People with severs and profound mental retardation who require the stability and quality of ICFs/MR and HCBS supports.

VOR * 836 S. Arlington Heights Rd., #351 * Elk Grove Village, Illinois * 60007

877-399-4VOR ph. * 847-258-5273 fax * tamie327@hotmail.com