Cultivating Opportunities in the Community

As Director of the Office on Disability, I am very excited to be able to report significant progress in the implementation of provisions that will expand opportunities for persons with disabilities to live in their communities. Within the department, we are taking the lead in coordinating the Community Living Initiative, which will allow more persons with disabilities who wish to live in their own homes to do so.

A regulation released today by the Centers for Medicare & Medicaid Services (CMS) will make it considerably easier for states to provide home and community based services in the Medicaid program, allowing people with disabilities to stay in their homes and contribute to their communities.

The regulation CMS is proposing would allow states to target multiple groups in a single home-and-community based (HCBS) waiver. Under current rules, states must serve one target group per waiver.  This creates administrative challenges for states that can delay opportunities for persons with disabilities to either remain in or transition to community living situations. The three target groups whose services can be combined include:

• Aged or disabled
• Persons with developmental disabilities
• Individuals with mental illnesses.

The proposed rule also clarifies what constitutes a true HCBS setting, and sets out new requirements for person-centered care plans. The goal of such waivers is to integrate people with disabilities into the social mainstream with equal opportunities. Individuals would have the ability to contribute to the design of their own care, consistent with the patient centered philosophy strongly supported by this Administration.

This proposed new rule will assist states in meeting their legal obligations under the Americans with Disabilities Act because states will be able to provide better-coordinated care to Medicaid beneficiaries with disabilities. Communities, and most importantly, Medicaid beneficiaries with disabilities will be able to thrive in the environment of their choice while contributing to the community at large. Every individual deserves to be treated with respect and dignity and this proposed new rule helps ensure that people with disabilities are extended equal opportunities.   

If you have thoughts as to how we can enhance the design of this program to advance community integration, we want to hear from you. The proposed rule, CMS-2296-P, will be open for public comment for 90 days after publication in the Federal Register, which you can read more about here.