Sen. Harkin says President Obama supports law to expand Medicaid to cover home, community services for disabled people

From MedPage:

WASHINGTON -- President Barack Obama supports a bill that would expand Medicaid to cover home- and community-based assistance for people with disabilities, said Sen. Tom Harkin (D-Iowa).

Speaking to a crowd of disability rights advocates June 8, Harkin said he broached the subject at a recent meeting with Obama and his healthcare adviser, Nancy-Ann DeParle. He said the president told him, "I consider it something we should do."

During the last session of Congress, Obama was a co-sponsor of Harkin's bill, the Community Choice Act, which would provide Medicaid payments for home- and community-based attendants to help people with disabilities perform daily activities, such as eating, dressing, and bathing, and participating in the community.

Currently, Medicaid reimburses for care in hospitals, mental institutions, and nursing homes, and bases coverage on age and diagnosis, rather than level of functioning.

While he said Obama's support is neither a glowing endorsement nor a promise that legislation would be rolled into healthcare reform, "now we have a president of the U.S. who is on our side in this effort."

A 1999 Supreme Court decision found that people with disabilities have the right to choose to receive long-term healthcare and support in the community, rather than in an institutional setting.

Despite that ruling, in 2007 about 70% of the Medicaid funding for people with disabilities paid for institutional services rather than home- or community-based services, according to the bill.

Supporters of the bill say it would be only a third as expensive to elderly adults or adults with disabilities through home- and community-based services as it would in a nursing home.

Still, the bill would initially cost about $2 to $4 billion annually.

"I know that's a lot of money, but when we're looking at a $1 trillion healthcare reform bill, 2, or 3 or 4 or 5% is not too much to ask to provide civil rights for an entire group of people," Harkin said.

Having a home healthcare worker may enable some disabled people to hold jobs they couldn't otherwise handle, which would in turn provide economic gains that could offset the costs of reimbursing for community-based care, Harkin said.

A draft of a healthcare reform bill by the Senate Health, Education, Labor and Pensions Committee, of which Harkin is a member, outlined a plan to create an insurance plan which people with disabilities could buy to pay for their community-based care. The draft bill does not propose extending Medicaid to cover community-based care.