Section 6086 of the Deficit Reduction Act of 2005 has not received much attention. It offers States a new opportunity to provide a full (or partial) range of community-based services for seniors and people with disabilities. Beginning now, January, 2007, States can use this new statutory provision without applying for a Medicaid waiver.

Here are some important aspects of Section 6086:

1. It applies to seniors and people with disabilities with incomes up to 150% of the poverty level: $14,700 for a single person and $19,800 for a couple. These income levels are higher than many States now provide for either MA community- based waiver services or MA state plan services, and could help many seniors Social Security.
2. Because no waiver application is required, there is no excuse that the process is too complicated.
3. These services can be targeted to persons BEFORE they go into a nursing home. This is important because, nationally, 11.8% of the persons IN nursing homes went into them directly from their own homes and had NOT been receiving any home health services for entering the institution; that's nearly 155,000 people in nursing homes as of 9/30/06! Why should anyone be admitted to an institution without at least being offered and provided community-based services?
4. There is no requirement under Section 6086 that persons even meet nursing home level of care criteria.
5. There is no "cost neutrality" requirement that MA waivers have.
6. States can limit the number of persons who will receive these services, so States will be able to monitor and control the financial aspects of offering and providing the services.
7. States can concentrate the Section 6086 services in areas of the State that historically have high concentration of nursing home enrollments.
8. These services can be consumer directed.
   
   Has your State started to offer Section 6086 community-based services? Will your State offer them? If not, how can your State continue to complain about MA expenditures, when it will not implement a program that will save MA costs by preventing many of the 11.8% of the persons entering nursing homes? [Your states's specific percentage of persons admitted to nursing homes without receiving any home health services can be found: http://www1.cms.hhs.gov/apps/mds/res3.asp?var=AB2&date=16 ]

Source: Steve Gold, The Disability Odyssey continues
Write to stevegoldada@cs.com, call 215-627-7100, or visit the website http://www.stevegoldada.com