Opposition to MiCASSA

VOR opposes S. 683, the Community Choice Act of 2009, introduced by Senator Tom Harkin (D-IA), and H.R. 1670, introduced by Rep. Danny Davis (D-IL). In past years, this legislation was called MiCASSA. If passed, the unintended effect of this legislation will be the elimination of necessary services for citizens with severe and profound mental retardation.

This legislation has been introduced in every session since the 105th Congress (1997. Like its predecessors, the Community Choice Act of 2009 proposes a new mandatory Medicaid entitlement for community-based personal attendant care services for individuals eligible for care in Intermediate Care Facilities for Persons with Mental Retardation (ICFs/MR) or nursing facilities.

At the time of the original introduction of this legislation in 1997, the Congressional Budget Office (CBO) estimated that 8 million people might be eligible. Assuming that only 2 million would actually request the benefit, CBO estimated an annual federal cost of $10-20 billion:

        “This bill would increase overall costs, however, because limited reductions in nursing home care would be more than offset by demand for the new services, including services for people who would not otherwise have entered an institution . . . CBO estimates that the bill could cost the federal government $10 billion to $20 billion a year.” (June O’Neill, Director, Congressional Budget Office, October 14, 1997).  [emphasis added]

The mandatory Medicaid entitlement proposal within S. 683 and H.R. 1670 is the primary reason for the high cost projections. For states to accommodate this increase in mandatory Medicaid expenditures, funding for optional Medicaid programs, such as the optional 1915(c) Home and Community-Based Services (HCBS) waiver, the optional state plan personal care services benefit, and the optional ICFs/MR program, will have to be cut. Quality and availability for the people who rely on these programs will suffer.

Conclusion

Expansion of community-based services, including attendant care services, is desperately needed. However, this expansion must not be accomplished by taking away services from Medicaid-eligible people with severe and profound mental retardation, who have even greater support and health care needs. Those who stand to be hurt by the good intentioned, but misguided, legislation -- S. 683 and H.R. 1670 -- are the neediest, most fragile, and most disabled of our nation’s citizens: People with severe and profound mental retardation who require the stability and quality of ICFs/MR and HCBS supports.