The Surgeon General’s Call to Action to Improve the Health and Wellness of Persons with Disabilities

Medicare and Medicaid-Home and Community-Based Programs

Many persons with disabilities rely on the federal-state Medicaid program and the federal Medicare programs of the Centers for Medicare and Medicaid Services (CMS) to assist with their health care needs. Both provide a public safety net for persons with disabilities; historically, both also have limitations (e.g., biases toward acute and institutional care and against preventive or home health care). In the past, people have been forced to “follow the money” to more expensive—often less appropriate—care. However, recent innovations are helping states to promote individual choice and community-based alternatives.

Medicaid

Home and community-based services are being provided by growing numbers of states through the CMS home-and community-based services program (HCBS) and through Independence Plus waivers. Information about these programs is available on-line, respectively at www.cms.hhs.gov/medicaid/1915c/design.asp and at www.cms.hhs.gov/independenceplus/.

• Medicaid Real Choice System Change Grants for Community Living are helping states rebalance their programs to provide meaningful health care choices to enable individuals with disabilities and long-term illnesses to lead meaningful lives in the community. While states determine the areas on which to focus, the program is yielding results in such areas as:
  • Consumer direction and control of medical and other services–including eliminating barriers, creating individualized budgets, promoting transitions and selecting services needed;
  • Consumer access to community-based, long-term care and supports, including workforce availability and single point of consumer entry;
  • State budgeting and reimbursement that provide optimum flexibility to meet individual consumer needs (for example, personal care attendants); and
  • Quality assurance in service provision, including consumer feedback to promote continuous quality improvement.
  • Integration of multiple service systems to focus on the needs of individuals making states’ long-term support systems more efficient, effective and responsive to individual choices.

The Medicaid Buy-In Program, authorized by Congress under the Ticket to Work and Work Incentives Improvement Act of 1999, recognizes that eliminating barriers to health care and creating incentives to work can greatly improve the financial independence and well-being of beneficiaries with disabilities. The program, adopted at state option, allows people to go to work while retaining essential Medicaid health care benefits.

Medicare

The Medicare Modernization Act includes a number of specific provisions that focus on the needs of individuals with disabilities who qualify for Medicare coverage:

• The Chronic Care Improvement Program is a new demonstration program for people with multiple chronic conditions. Under the program, CMS will contract with private organizations to offer self-care guidance and support to chronically ill beneficiaries, helping beneficiaries manage all aspects of their health, adhere to their physicians’ plans of care and ensure that they seek or obtain medical care that they need to reduce their health risks. Participation by Medicare beneficiaries will be voluntary; participants will not have to change plans or providers, or to pay extra to participate. They will be able to stop participating at any time.
• A new demonstration project in Missouri, Colorado and Massachusetts is assessing a new definition of “homebound” that removes the limitation based on actual time spent away from home, eliminating concern among many homebound persons that they will lose access to home-based care if they engage in any activities beyond their homes.
• New preventive services will become available in 2005, including an initial physical for new beneficiaries, coverage for cardiovascular screening blood tests for all beneficiaries and diabetes screening for high-risk beneficiaries.

These services come on top of the new Medicare Part D prescription drug benefit that will allow Medicare beneficiaries to enroll in drug coverage through a prescription drug plan or Medicare health plan with Medicare paying for 75% of the premium. Additional benefits for Medicare beneficiaries who have limited means will cover, on average, 95% of their drug costs. All the new Medicare benefits are voluntary; beneficiaries may choose to keep their existing traditional coverage. Until that program is in effect (2006), individuals with disabilities and older adults will be able to use new medication discount cards to garner savings of about 10 to 15% on their total drug costs, with savings of up to 25% or more on individual prescriptions.

Speedier Medicare Appeals can help ensure that individuals with disabilities are able to resolve appeals for Medicare benefits more quickly and efficiently as the result of a new Medicare-related program set in place by the Centers for Medicare and Medicaid Services.

Last revised: January 4, 2007