From: jfa@jfanow.org (Justice For All Moderator)

"White House Medicaid Demonstration Proposal"

Troy Justesen of the White House Domestic Policy Council
writes:

We recently learned that many of you do not have the
Administration's proposal sent to Congress on July 24,
2003, to provide significant new incentives and resources
for States to bring about a better balance between
institutional facilities and community-based alternatives
for many people with disabilities. This proposal, the "New
Freedom Initiative Medicaid Demonstration Act of 2003,"
would increase the ability of individuals themselves, and
their families, to make choices that work best for
them. The proposals in the bill would address barriers to
home and community-based care under Medicaid.

This draft bill is now waiting for sponsorship from members
of the House and Senate and it has not been assigned a bill
number. Below is a section-by-section bill summary.

======================

"New Freedom Initiative Medicaid Demonstrations Act of
2003"

Section-by-Section Summary

(Except as otherwise indicated, this bill amends provisions
of the Social Security Act. References to the "Secretary"
are to the Secretary of Health and Human Services.)

SEC. 2. DEMONSTRATION OF RESPITE FOR CAREGIVERS OF ADULTS.

Section 2 would authorize a ten-year demonstration project
covering FYs 2004-2013 enabling States to test the
effectiveness of respite care in permitting certain elderly
and disabled Medicaid beneficiaries who require continuous
care to remain in their own homes and communities. Such
respite care gives family members or other unpaid
caregivers a temporary respite from the responsibilities of
caregiving. Such respite may sustain their ability to
continue providing care and preclude the need for
institutionalization. The costs of State operation and
Secretarial evaluation of this demonstration would be paid
from $449 million of Medicaid entitlement funding made
available for purposes of this section.

SEC. 3 DEMONSTRATION OF RESPITE FOR CAREGIVERS OF CHILDREN
WITH SUBSTANTIAL DISABILITIES.

Section 3 would authorize a ten-year demonstration project
covering FYs 2004-2013 enabling States to test the
effectiveness of respite care in permitting certain
Medicaid-enrolled children with substantial disabilities,
who require continuous care, to remain in their own homes
and communities. The costs of State operation and
Secretarial evaluation of this demonstration would be paid
from $118 million of Medicaid entitlement funding made
available for purposes of this section.

SEC. 4. DEMONSTRATION OF HOME AND COMMUNITY-BASED
ALTERNATIVE TO PSYCHIATRIC RESIDENTIAL TREATMENT FACILITIES
FOR CHILDREN.

Section 4 would authorize a ten-year demonstration project
covering FYs 2004-2013 allowing States to test the efficacy
and cost-effectiveness of a home and community-based
alternative under Medicaid to psychiatric residential
treatment for children. A total of $504 million in
Medicaid entitlement funding will be available to States
for purposes of this section.

SEC. 5. DEMONSTRATION TO ADDRESS SHORTAGES OF COMMUNITY
SERVICE DIRECT CARE WORKERS.

Section 5 would authorize $3,000,000 for discretionary
grants to States for FY 2004 to address shortages of
community service direct care workers, who provide services
to individuals in their homes and communities. Funds would
be used to identify and test approaches to recruiting and
retaining such workers.

SEC. 6. MONEY FOLLOWS THE INDIVIDUAL REBALANCING
DEMONSTRATION.

Section 6 would appropriate $1.75 billion over five years
for competitive grants to States to develop and implement a
strategy to re-balance their long term care systems in
order to (1) offer individuals who reside in institutions
more choice over whether to live in their own communities;
and (2) to reduce reliance on institutions and increase
community-based options over time. In the first year of
such transition to community-based care, the Federal
government would pay 100 percent of the State's Medicaid
costs for community-based services for such individuals,
after which the State would pay its normal share of such
costs. The State would also include a plan for quality
assurance.

SEC. 7. PRESUMPTIVE ELIGIBILITY FOR CERTAIN ELDERLY AND
DISABLED PERSONS.

Section 7 would give States the option of providing
individuals with home and community-based services under
Medicaid for up to 90 days while their eligibility for
Medicaid is being determined. The proposal would reduce
the extent to which individuals move to nursing facilities
from hospitals due to the delays involved in establishing a
persons eligibility for the home and community-based waiver
services that would allow them to return home. The Federal
government will pay its share of the Medicaid cost for the
first 90 days of community services regardless of whether
or not the individual is ultimately deemed Medicaid
eligible.

SEC. 8. MEDICAID ELIGIBILITY OF SPOUSE OF INDIVIDUAL WHO
PERFORMS SUBSTANTIAL GAINFUL ACTIVITY DESPITE SEVERE
MEDICAL IMPAIRMENT.

Section 8 would continue Medicaid eligibility for spouses
of disabled individuals (eligible for Medicaid services
under Section 1619 (b) of the Social Security Act) who
return to work. Under current law, individuals with
disabilities might be discouraged from returning to work
because the income they earn could jeopardize their spouses
Medicaid eligibility. This proposal would extend to the
spouse the same Medicaid coverage protection now offered to
the disabled worker. The total federal cost is projected to
be $95 million over five years, with $16 million proposed
for FY 2004.

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