RECOMMENDATIONS FOR LONG-TERM CARE COMMISSION

Lutheran Services in America Disability Network (LSA-DN) is a nationwide association of Lutheran social ministry organizations serving the needs of people with intellectual and developmental disabilities and related conditions. LSA-DN includes 22 members that provide support to more than 23,000 individuals in 33 states and the U.S. Virgin Islands.

LSA-DN believes that people with intellectual and developmental disabilities should be full participants in community with the right to determine their full life in the community, including where they live, work and contribute to society. Individuals with intellectual and developmental disabilities should have a real choice about where and how they receive quality services and supports. This means the transformation of the Medicaid structure so that individuals are equally entitled to home and community-based services (HCBS) that meet their individual needs as they are now entitled to institutional care. It is not only the just thing to do, but it is cost effective and supported by the Olmstead Supreme Court Decision. PERSON-CENTERED MEDICAID REFORM Remove Medicaids institutional bias by mandating HCBS as the standard benefit and allowing people with disabilities. Transform the current system so that non communitybased choices, including ICF-MR, would then require a waiver. Implement policies that allow people with disabilities to design services and supports to facilitate participation in community life as they choose. Such policies enable consumers to choose their service provider(s) and control their service delivery, utilizing the ABLE Act and other successful state self-directed supports as models. Any managed care system needs to be self-directed, transparent, consistent and include an adequate appeal process.

PROTECT AND STRENGTHEN MEDICAID Increase the number of people with disabilities receiving HCBS services, including those currently on waiting lists, those enrolled but not yet receiving services and those not on a waiting list and not receiving services of any kind. Provide more transparency and consistency in tracking waiting lists so that the actual longterm services and supports (LTSS) need is understood. Utilize data gathered through tracking to further consumer choice and foster robust private partnerships.
Lutheran Services in America Disability Network 100 Maryland Ave. NE, Suite 500, Washington, DC 20002 202.499.5831, www.lutheranservices.org

Seamlessly coordinate Medicaid benefits with other federal and state programs that facilitate community living, including housing, transportation and employment.

RESTRUCTURE MEDICAID FUNDING Expand and expedite implementation of the Community First Choice option, state rebalancing, money follows the person and other programs that provide enhanced federal matching dollars to states and allow expanded access to HCBS to individuals with intellectual and developmental disabilities. Shift funding and service delivery from state institutions to HCBS in states where there remains a strong funding bias towards state institutional services, so that services are administered in the most person-centered and cost effective manner. Create realistic, transparent rate setting based on true consumer need so that people with disabilities are able to choose high quality supports administered by private providers. Fund the system adequately so that people with disabilities and the private services provider they select can recruit, retain and compensate direct care workers to limit unnecessary turnover, maintain continuity of supports and further maximum community integration.

For more information please contact Sarah Meek, Director of Public Policy and Advocacy, at (202) 499-5831 or smeek@lutheranservices.org.

Lutheran Services in America Disability Network 100 Maryland Ave. NE, Suite 500, Washington, DC 20002 202.499.5831, www.lutheranservices.org