Congress Pushes Back on HCBS Rule Listing Farmsteads as "Isolating"

The Centers for Medicare and Medicaid Services (CMS) provided states with “Guidance on Settings that have the Effect of Isolating individuals receiving HCBS from the Broader Community.” "Farmsteads or disability-specific farm communities" are among the settings listed that may no longer qualify to receive Medicaid funding for Home and Community-Based Services (HCBS) under the new HCBS settings rule.

Many family groups have initiated projects to create planned communities, including "farmsteads or disability-specific farm communities", as a response to the poor quality and general lack of availability of residential options for people with disabilities. These communities have now been singled out for isolating people from the broader community:

From page two of "Guidance..."

"...Farmstead or disability-specific farm community: These settings are often in rural areas on large parcels of land, with little ability to access the broader community outside the farm. Individuals who live at the farm typically interact primarily with people with disabilities and/or staff…[a number of assumptions about the lack of integration with the broader community follows.]…Thus, the setting does not facilitate individuals integrating into the greater community and has characteristics that isolate individuals receiving Medicaid HCBS from individuals not receiving Medicaid HCBS.” The assumptions about isolation are hotly disputed by people who live and participate in these programs and their families.

In a letter dated 1/26/15, to Sylvia Burwell, the Secretary of the U.S. Department of Human Services, Ohio legislators have pushed back on the idea that these settings are isolating and should not receive HCBS funding:

“…Ohio is home to several farmstead programs, which provide vocational and educational programs, and residential support for people with autism. We have heard from constituents across Ohio that these farmstead programs are a very successful environment for a large percentage of the autism community. It is our understanding that while individuals spend a good deal of time in the farmstead environment, they are exposed regularly to the outside community for a variety of activities. Overall, the farmstead setting provides unique support for individuals with autism enable them to maximize their potential.

“We have concerns that this rule could inhibit the availability of these types of services for individuals who benefit from them. Many of these participants have been attending and participating in these services for years. We urge you to reconsider this guidance so that the option for individuals to live and work in a rural, farmstead or disability-specific farm community remains a choice for individuals and remove them from the list of having an isolating effect.”

The letter is signed by one U.S. Senator and  13 members of the House of Representatives from Ohio, including John Boehner, the Speaker of the House.

For more information on choice in community settings see the Coalition for Community Choice website and  the CCC Blog - "Advancing the principle that community can be experienced in all residential settings".