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HHS moves to enlarge pool of Medicaid recipients living at home, going to work
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Jan. 7, 2003 -- The U.S. Dept. of Health and Human Services has begun moving to allow more disabled people to receive services in their own homes, rather than in institutions -- and to initiate changes that allow people to retain medical coverage while returning to work.

A 1999 Supreme Court decision on the Americans with Disabilities Act known as the Olmstead decision says people must receive services in the "most integrated setting." In keeping with this, the goal of the Bush administration's New Freedom Initiative, announced soon after the president took office, is to reduce barriers to full community integration for people with disabilities. Last spring HHS Sec. Tommy Thompson unveiled two new waiver "templates" he said were designed to help states better use the Medicaid program to enable people with disabilities to choose services in their own homes and communities (Information about this program, called "Independence Plus," can be found online at )

In late November, Sec. Thompson approved Nevada's plan to expand the help it provides to disabled adults so they can remain in their homes and out of nursing facilities, allowing the state under a Medicaid "waiver" to increase five-fold the number of people served -- from 304 to 1,716 people. The new waiver program will provide services to persons of any age who otherwise would require care in a nursing home. Previously, the waiver was limited to people ages 64 and older. They will receive home support, personal care services, respite care, transportation, home delivered meals and other services to keep them at home. Nevada is also revising its waiver to allow consumers some control over choosing, training and supervising personal care providers (

In early December, HHS announced the approval of Pennsylvania's plan to expand the number of disabled adults who receive assistance through Medicaid so they can remain in their homes and out of nursing facilities (

And on Dec. 16, the Department approved Arizona's plan to allow people with disabilities who return to work to retain their Medicaid coverage. Arizona will offer Medicaid to eligible people with disabilities between the ages of 16 and 64 with family incomes up to 250 percent of the federal poverty level, with no limit on personal or family resources (for 2002, the federal poverty level is $8,860 for an individual). These changes fall under the Ticket to Work and Work Incentives Improvement Act of 1999. Arizona officials expect over 700 people to enroll under the two new optional eligibility coverage groups during the first year (

For more about Ticket Ticket to Work and the Work Incentives Improvement Act of 1999, visit

More about the New Freedom Initiative can be found online at

For more on the Olmstead decision, visit

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