October 4, 2007

The Honorable Tom Harkin
731 Hart Senate Office Building
Washington, DC 20510

Dear Senator Harkin:

AARP commends you for your leadership in seeking to expand home and community-based services. Your sponsorship of the Community Choice Act (S. 799) shines light on the issue of Medicaid’s institutional bias and the need to expand home and community-based services.

Among individuals age fifty and older, 89 percent say they want to remain in their home for as long as possible. Yet Medicaid, the largest payer of long-term care, has an institutional bias _ individuals who meet specific eligibility criteria are entitled to care in a nursing home, but not necessarily to home and community- based services (HCBS). HCBS are optional, and in many cases, states seek waivers to provide HCBS under Medicaid. Individuals should not be forced to receive services in nursing homes when they prefer and are able to receive services in a home and community-based setting that is generally less expensive.

Over time, states and the federal government have begun to rebalance Medicaid to bring greater attention, efforts, and resources into HCBS. This is due to factors such as consumer demand, the Olmstead Supreme Court ruling, and the desire to stretch Medicaid dollars further. The Community Choice Act (S. 799) further expands access to HCBS by requiring states to provide community-based attendant services and supports (assistance with daily activities) to individuals eligible for Medicaid who require an institutional level of care and choose to receive community-based attendant services and supports.

Lessening and removing the institutional bias in Medicaid is an important part of long-term care reform. We also note that while most individuals prefer to receive services in home and community-based settings and this access needs to be expanded, there will continue to be individuals who receive care in nursing homes. High quality of care in nursing homes is vital and should be an important consideration as quality HCBS options are expanded.

As the Congress examines ways to increase options for HCBS, it is also important to consider other issues that must be addressed in order to truly make these services available to those who need them and enable individuals to live in the homes and communities they choose. The critical elements include: support for family caregivers, an adequate workforce, financing options, quality supports and services, and livable communities.

Reforming long-term care must become a national priority, and we appreciate your leadership in bringing these issues before the Congress. If you have any further questions, please feel free to call me or have your staff contact Rhonda Richards of our Federal Affairs staff at (202) 434-3770.

Sincerely,

David P. Sloane
Senior Managing Director
Government Relations and Advocacy

cc:
Senator Baucus
Senator Grassley