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MiCASSA Charles Schleininger corsair schleini@lemoorenet.com Medical Community attendant Services & Supports Act

For decades people with disabilities, both young & old, have wanted alternatives to nursing homes & other institutions when they need long term services. Our long term care system has a heavy institutional bias. Every state that receives Medicaid must provide nursing home service, but community based services are optional. Over 80% of Medicaid long term care dollars ($41 billion) pay for institutional services, while the remaining must cover all the community based waivers & optional programs.

America's long term service system must change. Created over 30 years ago, it is funded mainly by Medicare & Medicaid dollars. These are medical dollars which were not originally conceived to meet long term care needs of people. A national long term service policy should not favor any one setting or the other. It should be neutral & allow the users to choose where services should be delivered. The current system is not neutral.

Community services on average have been shown to be less expensive - & more desired by individuals - than institutional services. Nursing home care costs taxpayers more than it costs to support people in their own homes, even when these people are receiving other public benefits. People with disabilities, both young & old, including those with significant mental and/or physical disabilities, want services in the most integrated setting possible. People with disabilities & their families want REAL choice, which means:
- equitable funding opportunities;
- no programmatic or rule disincentives to community service;
- options for services delivery to include agencies, vouchers & fiscal intermediaries.



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