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New rule to enrich Medicaid home care for those with disabilities

The U.S. Department of Health and Human Services has just announced a long-awaited rule meant to improve community and home-based services for Medicaid recipients with disabilities. The rule, which is expected to be published in the Federal Register this week, not only clarifies what constitutes an acceptable community-based or home setting for all those with disabilities but also marks an important change in perspective on how people deserve to be treated.

Today many people with disabilities receive assistance through both Social Security disability and Medicaid that allows them to live at home or in a home-like environment. Decades ago, people whose conditions required extensive support, particularly those with mental disabilities, were more often sent to live in institutions for mental diseases. These were often prison-like facilities where patients had no right to privacy or autonomy, and were not expected to live full lives.

Over the course of many decades, people with disabling conditions fought for and won the right to live as independently and fully as possible, and this has been a tremendous benefit. Still, even as treatment shifted toward home and community-based care, people with disabilities have often found themselves subjected to institution-like treatment. When housing and care settings were assigned to Medicaid recipients, they were often chosen for location and physical characteristics rather than what individuals might prefer.

Under the new rule, nursing homes, intermediate care facilities and institutions will no longer qualify as “home and community-based settings” for Medicaid. Instead, such settings must meet certain criteria to prove they are focused on patient outcomes. Most important, homes for people with disabilities will be required to protect residents’ privacy rights and maximize opportunities or independent choices about the home environment, daily activities and interactions with others.

“People with disabilities and older adults have a right to live, work and participate in the greater community,” said HHS Secretary Kathleen Sebelius adding that the new rules “will help ensure that all people participating in Medicaid home and community-based services programs have full access to the benefits of community living.”

States that offer home and community-based services through Medicare are expected to develop transition plans right away.

For people with disabling physical or mental conditions needing substantial support, these new requirements are a very positive step toward a life that is as full, independent and self-directed as possible.

Source: Disability Scoop, “New Medicaid Waiver Rules Set To Take Effect,” Michelle Diament, Jan. 10, 2014

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