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Administration proposes funds for 'freedom'
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Jan. 28, 2003 -- A new $1.75 billion, five-year program to help Americans with disabilities transition from nursing homes or other institutions to living in the community will be part of the budget Pres. Bush will unveil next month. The Bush administration says it's just one of several new efforts in the FY 2004 budget for the administration's New Freedom Initiative.

Other than a Jan. 24 mention by Austin American Statesman reporter Mary Ann Roser in story about HHS Sec. Tommy Thompson's visit to Austin ( "Americans need to get fit, U.S. health secretary says," Jan. 24 ) and a brief AP wire story, news of the funding didn't make it into major media outlets.

The proposals, says HHS, build on recommendations made to the President last year in "Delivering on the Promise," a comprehensive survey of federal policies and rules that may impede community living for those with disabilities. "

The $1.75 billion demonstration program "would assist states in developing and implementing a strategy to 're-balance' their long term care systems so that there are more cost-effective choices between institutional and community options," says HHS. They can In "pay the full cost of home and community-based waiver services for one year, after which the participating states would agree to continue care at the regular Medicaid matching rate." (Read full press release at

While the demonstration will undoubtedly help many individuals stay in their homes rather than being forced into institutions, the administration's budget proposal does nothing to change the inherent "institutional bias" in Medicaid law. By law, states must provide "beds" in nursing homes to people eligible for Medicaid; they are not required to allow the person to use the funds at home; in fact, only through a "waiver" will the federal Center for Medicare and Medicaid Services allow a state to do this. These new administration funds will help states with waiver programs.

There are a number of groups working to remove the "institutional bias," including Advancing Independence: Modernizing Medicare and Medicaid ( The disability rights activists of ADAPT push for passage of the Medicaid Community Attendant Services and Supports Act (MiCASSA). (Read more about MiCASSA at

For more links on this topic, read our Oct. 1, 2002 E-Letter, "ADAPT to challenge nursing home industry on community services," online at and our information on the "institutional bias" in long-term care policy at Read about the New Freedom Initiative at

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