Response to the Fiscal Cliff from National ADAPT

2013-ADAPT-FiscalCliff
-- Photo of a large group of disability advocates and a few police officers gathered outside a building. Photo was taken in 2012 during a disability rights rally staged by ADAPT in Harrisburg, Pennsylvania.
Statement on the “Fiscal Cliff” from National ADAPT

The deal that averted the “fiscal cliff” included provisions affecting long term services and supports. The legislation repealed part of President Obama's health care law that created the Community Living Assistance Services and Supports (CLASS) program. Although CLASS was repealed, the fiscal cliff legislation also created a new Commission to look at long term services and supports.

The Commission will be made up of 15 people appointed by the President and Congressional leaders. The members of the Commission are supposed to represent the broad range of groups affected by or interested in these issues which will include:

* consumers of long–term services and supports and related insurance products, as well as their representatives;
* older adults;
* individuals with cognitive or functional limitations;
* family caregivers for individuals described in clause (i), (ii), or (iii);
* the health care workforce who directly provide long–term services and supports;
* private long–term care insurance providers;
* employers;
* State insurance departments; and
* State Medicaid agencies;

The Commission is supposed to be appointed no later than 30 days after the law is enacted. The Commission is then charged with developing a plan for the establishment, implementation, and financing of a comprehensive, coordinated, and high–quality system that ensures the availability of long–term services and supports for individuals in need of such services and supports. The plan is supposed to specifically address the needs of elderly individuals, individuals with substantial cognitive or functional limitations, other individuals who require assistance to perform activities of daily living, and individuals desiring to plan for future long–term care needs.

While some people are concerned that the work of this Commission could end up “sitting on a shelf,” it's time that we seriously look at these issues. That hasn't been done since the Pepper Commission over 20 years ago. During this time, ADAPT members have been working diligently to change the system that provides long term services and supports. We created the Real Choice Systems Change grants and the Money Follows the Person Program. We got the Centers for Medicare and Medicaid Services to establish a referral process so that nursing facility residents don't only have their interest in returning to the community documented, but actually are referred for assistance to make that happen. We shifted literally billions of dollars from institutions into the community. Most recently, we created the Community First Choice Option which transforms how long term services and supports get provided by the states.

This Commission gives us an opportunity to end Medicaid's institutional bias and reform the systems for providing long term services and supports. ADAPTers from all over the country – most of whom use long term services and supports – have developed a strong foundation for such reform. In fact, ADAPT has already put forward principles for Real Medicaid reform. These principles – applied to the entire system – would transform how long term services and supports are provided. That's why ADAPT needs to be represented on this Commission.

But even having ADAPT on the Commission won't assure that the Commission will do what needs to be done. The various “stakeholders” identified for the Commission all have their own interests. That's part of the reason it has taken so long to change the system. We need members of the Commission who will support the disability community's efforts to change the system so that seniors and people with disabilities are able to live in the community – rather than be forced into institutions. We need people to serve on this Commission who understand that having control over your life includes being able to decide who touches your body, when they assist you and how they do it. We need people on this Commission who value our first–hand knowledge of the system and have a history of working in partnership with the disability community and our disability–led organizations.

ADAPT urges the disability community to review the list of groups that need to be represented on the Commission and identify strong allies of our community who could be appointed. We also call on the President and leaders of Congress to work with ADAPT and the disability community to appoint a Commission that will address these critical issues and finally FREE OUR PEOPLE!

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