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Strategies to Improve Access to Medicaid Home and Community

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Statement of Senator John F. Kerry
Finance Committee Hearing
"Strategies to Improve Access to Medicaid Home and Community"

Wednesday, April 7, 2004

Last September, at the conclusion of ADAPT's "Free Our People" march, I joined Senator Harkin and many other of my colleagues in calling for Congressional hearings on the MiCASSA bill and for this landmark legislation to be enacted without further delay. I appreciate the willingness of Chairman Grassley and Ranking Member Baucus to conduct such an important hearing and believe this is a crucial first step in bringing us closer to ending the institutional bias that exists in Medicaid today.

But let's stop fooling ourselves. We don't need a hearing to discuss strategies for improving home and community based services under Medicaid. We know what works. We know what needs to be done. What we must do is to summon the political will to make it happen. People with disabilities are rightfully tired of the excuses they hear out of Washington and in State Houses across the country on why, for one reason or another, they must wait for justice to be delivered. Justice delayed is justice denied. No wonder people in wheelchairs are chaining themselves to fences and taking to the streets. If the tables were turned, we would be doing the same.

This is America. No one should be imprisoned in a nursing home or denied the help they need to eat, bathe, dress and live in their communities. We must right this wrong by making the policy changes necessary to fund people and their needs, not just programs and their rules.

Let me start by saying that I am one of the biggest supporters you'll ever meet for strengthening and protecting the Medicaid program. I strongly oppose the Bush Administration's proposal to block grant it to the states. Medicaid's entitlement should never be threatened. I am deeply concerned about the growing trend among states using Medicaid as a source for service cutbacks and eligibility restrictions to balance budget deficits. States are already woefully in non-compliance with the Olmstead decision, in part, due to the fiscal stresses many of their budgets are experiencing in this troubled economy. Fiscal relief for states - in the form of higher Medicaid reimbursements - should be a consideration during this federal budget cycle. Without additional relief, optional Medicaid programs and benefits for people with disabilities are sure to be threatened - from implementation of the Ticket to Work and Work Incentive Improvement Act, to growing waiting lists that result from reduced slots under current home and community based waiver programs. But such funding should only be offered in exchange for assurances that Medicaid coverage will be preserved or expanded - not used as a slush fund for tax cuts or to cover other state funding shortfalls. Keeping Medicaid strong should remain a top priority for this Committee.

But for all of Medicaid's strengths, there is one inherent weakness in the way the program is structured - and that is the cruel choice that many people with disabilities must make to receive any assistance at all: leave your home, your family, your friends, and your community to live in an institution, or be denied care. What kind of a choice is that? It's un-American. We must stand for freedom, independence, and real choices for people with disabilities and it starts with assuring equal access to community living services to people with disabilities of all ages nationwide.

The ADA stands for the proposition that people with disabilities have the right to be a part of the American community rather than to live their lives separate and apart from it. For these reasons, I am a proud original cosponsor of MiCASSA and the Money Follows the Person Act. Passage of both of these bills is vital to ending the institutional bias that makes it impossible for millions of Americans to exercise the most basic of human liberties: freedom, choices, and independence. These are the birthright of every American. Our nation's long-term care policies and programs must promote rather than undermine these cherished values.

The time has come and gone for us to get serious about making these needed changes to improve the lives of people with disabilities. I look forward to working with you, Chairman Grassley, and members of the Committee, to move as quickly as possible from just talking about the problem to actually implementing the solutions. In the 1960's, Martin Luther King answered those who claimed that we must go slow to right the great and seemingly insoluble injustices of his day in a book entitled, "Why We Can't Wait." Today, we will witness living proof of why we can't wait to right these grave and seemingly insoluble injustices of our own day and time.

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