The Center for An Accessible Society Disability Issues Information










May, 2003 -- The Medicaid Community-Based Attendant Services and Supports Act of 2003, or MiCASSA (S. 971 and H.R. 2032), was re-introduced in Congress for the third time. It is the result of efforts of many organizations in the disability community that are trying to get Medicaid to pay for services in one's own home, not a nursing home. The bill calls for Medicaid funding to be used for personal assistance services and supports for people of all ages in their homes and communities, rather than only in an institution -- paying for asssistance with bathing, dressing, meal preparation, money management and certain health-related tasks.

MiCASSA redirects the focus of the Medicaid long-term services program from institutions to home and community services and supports. It enables people to make real choices.

"Most Americans who need long term services and supports would prefer to receive them in home and community settings rather than in institutions," said Sens. Harkin and Specter in a letter to Senate colleagues when an earlier version of this bill was in Congress. "And yet, too often, decisions relating to the provision of long term services and supports are dictated by what is reimbursable under Federal and state Medicaid policy rather than by what individuals need. Right now, the Medicaid program includes a significant bias toward reimbursing services provided in institutions over services provided in home and community settings (research reveals seventy-five percent of Medicaid funds pay for services provided in institutions).

"We believe that no individual should be forced into an institution to receive reimbursement for services that can be effectively and efficiently delivered in the home or community," they said.

Read Sens. Harkin's and Specter's statement on MiCassa

More about MiCassa from ADAPT, the group behind the legislation.

Read more about the nation's institutional bias

What are "personal assistance services?"

MiCassa was last introduced in 1999, Read about the 1999 MiCassa in Ragged Edge magazine

More on the 1999 bill from
Liberty Resources

Follow the progress of MiCASSA at








The following sites contain information that may be of interest. Please bear in mind that the information at these sites is not controlled by the Center for An Accessible society. Links to these sites do not imply that the Center supports either the organizations or the views presented.
Consumer Choice and Control:
Personal Attendant Services and Supports in
Report of the National Blue Ribbon Panel on
Personal Assistance Services, August, 1999

Directory of Publicly Funded Personal Assistance Programs from the World Institute on Disability

"Understanding Medicaid Home and Community-Based Services: A Primer" -- from the U.S. Dept. of Health and Human Services, available at

Information on Home & Community-Based, Consumer-Directed, and Personal Assistance Services from the Office of Disability, Aging and Long-Term Care Policy at the U.S. Dept of Health and Human Services


How States' "Nurse Practice" Acts work against consumer direction -- from the January, 1999 Ragged Edge magazine






Expert sources

Nursing home data

Abuse of seniors under-reported, says study

The Institutional Bias of Public Policy

Consumer Direction in Personal Assistance

Study Validates Consumer Control's Superiority

In-Home Services and Safety

In-home services: Implementing the Olmstead decision

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