Senator Chuck Schumer introduced S-2427, the Disability Integration Act, on December 5, 2015, to counteract discrimination in Medicaid funding which is disproportionately allocated towards nursing home services. One effect of the bill could be to force States to allocate funds within their Medicaid budgets for Home and Community-Based Services (MLTSS-HCBS) for Medicaid applicants who can reside in the community with adequate long-term services and supports. Some States have no HCBS program at all because it is a “waiver” of the federally-mandated institutional Medicaid program, which pays for nursing home care for eligible individuals. Other States have so few slots that a person who applies will never come off of the waiting list.
According to the gov.track summary, “States, local governments, or insurance providers may not discriminate against such individuals in the provision of community-based services by: (1) imposing prohibited eligibility criteria, cost caps, waiting lists, or payment structures; (2) failing to provide a specific community-based service; or (3) requiring an individual to receive a service in a congregate or disability-specific setting.”
This Bill is an important step to get Congress talking about how to implement a community-integration mandate that dates back to the U.S. Supreme Court’s decision in Olmstead. It is a crying shame that a Medicaid-eligible frail disabled or aged person has to leave their community and move into a nursing home — or remain in a nursing home after their post-hospital care rehabilitation — when they could thrive in the home environment, just because the Medicaid dollars are only available in the nursing home.
New Jersey has an HCBS program for Medicaid applicants, but it is only a part-time program. It used to be called “Global Options,” and previously, there was an income cap which barred people whose monthly income exceeded three times the federal poverty rate. Fortunately, that restriction was lifted, so now, home care applications are expanding. Read my next post for more about the process.
For legal advice and help with your Medicaid application or appeal, call us at … 732-382-6070