The Centers for Medicare and Medicaid Services (CMS) is proposing to change regulations for Home and Community Based Services (HCBS) waivers. These Medicaid waivers are granted to states to fund services in community settings for people who would otherwise be eligible for institutional care in a hospital, nursing facility, or Intermediate Care Facility for the Mentally Retarded (ICF/MR).
If adopted, these proposed regulations will have a significant effect on people with developmental disabilities by limiting the settings in which waiver services can be provided and changing the person-centered planning process for developing an individual plan of service. They would also increase state administrative flexibility by allowing states to combine previously targeted populations under one waiver. Currently, people with developmental disabilities are covered by the Michigan Habilitation Supports Waiver (HSW) that funds services in a variety of settings including the person's own home (either living independently or with family), supported living sites, group homes, day programs, supported employment, and skill-building and specialized community-based work programs.
ISSUE #1: CMS must consider the economic climate in which changes to regulations will occur and protect people with developmental disabilities from potentially harmful effects.
Many state governments, especially Michigan's, are in dire financial straits. If given the incentive and opportunity by CMS, most states would likely reduce or shift Medicaid expenditures by limiting the choice and availability of services for people with developmental disabilities and their families. These proposed regulations give states the excuse to do just that and could result in significant harm to people with developmental disabilities.
Some advocacy groups, in their zeal to promote full community inclusion for every person with a disability, have supported limits on choice through the elimination of or restrictions on access to programs and services that they believe are segregating and discriminatory. Others, especially people advocating for loved ones with more severe cognitive and behavioral disabilities, recognize the importance of maintaining a full spectrum of specialized services and living situations that meet the diverse needs of this population. It is clear from the CMS proposal that the agency has only listened to advocates who favor limiting the settings in which HCBS will be provided. Not one opinion in opposition to this approach is mentioned in the background information or account of responses received from a previous solicitation of comments on these issues in 2009.
CMS should not allow or encourage states to eliminate necessary options under the guise of promoting community integration.
Link to proposed regulations (CMS-2296-P)
Submit comments here.
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