Clinton-Gore Administration Announces New Action Promoting Home and Community Based Services and Housing Options for People with Disabilities (7/26/00)

Clinton-Gore Administration Announces New Action Promoting Home and Community Based Services and Housing Options for People with Disabilities (7/26/00)

Commemorates the 10th Anniversary of the Americans with Disabilities Act

Today, Vice President Gore announced that the Clinton-Gore Administration will launch a series of major new initiatives designed to promote the delivery of home and community-based services for people with disabilities of all ages. The initiatives include a new $50 million investment in FY 2001 to help states more easily offer services to people with disabilities of all ages in the most integrated setting appropriate to their needs; new guidance to state Medicaid directors that will clarify Medicaid coverage for home and community based services and help them comply with the Olmstead Supreme Court ruling; and a new public-private partnership between HHS, HUD, and the National Program Office on Self Determination to create new models to help individuals with disabilities in institutional settings transition into the community. In addition, the Vice President announced new measures to increase home ownership for persons with disabilities; extend incentives for employment for individuals with disabilities to a broader range of housing assistance programs; and promote the development of new assistive technology for people with disabilities.

To achieve this vital goal the Federal Government, States, communities, the private sector, the aging community and people with disabilities must work together to identify and actively pursue effective strategies for:


The Clinton-Gore Administration supports a $50 million investment in FY 2001 to provide grant funds to states, together with their disability and aging communities, to develop comprehensive, effective plans for placing qualified persons with disabilities in the most integrated setting appropriate to their needs.

These new grants, allocated from the previously unspecified portion of the health care quality assurance as announced in this year's midsession review, are identical to those included in the Medicaid Community Attendant Services and Supports Act of 1999. They would actively involve people with disabilities and their families in working with each state to develop programs that enable people with disabilities to have a real choice in where they want to live and receive services.

These funds will help states develop comprehensive, effective working plans as endorsed by the U.S. Supreme Court in Olmstead v. LC. The grants will support States in partnering with their disability and aging communities to identify ways to avoid unnecessary institutionalization and advance community-based care in ways that are realistic, equitable and affordable. Every State that is awarded a system change grant will work with a newly established consumer task force comprised of representatives from the disability and aging communities and service providers.

Grants can be used to:


The Administration will release new guidance to states on their ability under the Medicaid program to support the implementation of the Olmstead Supreme Court decision. This guidance clarifies existing options to: assist people with disabilities in making a successful transition into the community; expand the availability and quality of community-based care services; and ensure that home and community-based services are available on an equal basis to all qualifying individuals with disabilities. This new guidance will:

Assist people with disabilities to make a successful transition from nursing homes and other institutions into the community.

Waiver Services: The guidance explains the quickest way a State can begin using Medicaid waiver funds to help people move out of institutions back into their communities.

Coverage of Community Transition Expenses: The guidance details how Medicaid can be used to pay for services and one-time expenses incurred when a person moves from an institution into the community. Covered services can include up to 6 months of case management to identify and obtain needed services as well as accessibility assessments and modifications of the new home or apartment.

Personal Care Expenses to Avoid Reinstitutionalization: HCFA will now allow States to use Medicaid to continue to pay for personal care for a period of up to two weeks while a person with a disability is hospitalized or absent from his or her home. This will enable a State to help individuals avoid losing their attendants and risking unnecessary institutionalization. This will provide parallel coverage to people whether they are living in a nursing home or in the community.

Expand access to home and community based services.

Habilitation: The guidance makes clear that habilitation services can be provided to individuals with the full range of developmental, physical and mental disabilities (not just those with developmental disabilities). This is important because habilitation services focus on assisting individuals to acquire, retain and improve skills important for living in the community.

Out of State Services: The guidance explains how a Medicaid program can pay for services provided to one of its beneficiaries in another state when it is in the beneficiary's best interest to do so, such as when a person needs to access services in rural or other underserved areas, a parent needs to be near his or her children, or a student attends college out of state.

Assure comparability in Medicaid services.

Home Health: The guidance informs States that they may no longer require that people meet the more narrow Medicare definition of "homebound" in order to receive Medicaid home health services. Specifically, HCFA indicates that such a State-imposed limit violates Medicaid's requirement that home health services be made available on a comparable basis to anyone on Medicaid who would qualify for nursing home care. (States can set reasonable limits that do not arbitrarily deny or reduce the amount, duration or scope of a required service solely because of a person's diagnosis, type of illness, or condition, but the guidance will ensure that no one loses access to home health services simply by leaving home and spending time in the community.)


Today, Vice President Gore announced that HHS and HUD will commit to a new investment, subject to appropriations, of nearly $20 million over five years in a public-private partnership with the National Project Office on Self Determination. The agencies are committing $5.5 million for the first year, subject to the availability of the appropriation, and are seeking to commit an additional $14 million over the life of the partnership. This unique partnership, which will also utilize on multi-million dollar investments already made by these agencies, is entitled Access Housing 2000. It will focus on expanding the availability of accessible, affordable housing. This national demonstration project will provide a model for a coordinated response to the Supreme Court's decision in Olmstead v. L.C.. The project will begin with approximately 400 beneficiaries residing in targeted regions, with a goal, depending upon available resources, of reaching 2000 persons at full implementation.

Participants will include individuals with disabilities who have very low incomes and who currently reside in nursing homes, state institutions, Intermediate Care Facilities for the Mentally Retarded, group homes, their parents' homes, and other community-based residential programs. The goal is to reach a broad geographic sweep, with a target of up to forty states and territories at full implementation.

The demonstration project will use Section 8 housing vouchers, Nursing Home Transition Grants, Ticket to Work and Work Incentive Improvement Act grants, and other resources in a targeted manner to help individuals with disabilities make this transition. Access Housing 2000 will also reach out to other potential public and private partners to encourage them to bring additional resources to this effort. In addition, the partners will explore ways to increase the use of individual development accounts (IDAs) for low- to moderate- income individuals with disabilities and their families.


The Vice President announced a new proposed rule that would expand incentives for employment for people with disabilities, extending earned income disregards, currently applicable only to public housing, to tenant-based Section 8 housing vouchers, the HOME program, the Housing Opportunities for People with AIDS program, and the Supportive Housing for the Homeless program. It also clarifies that deductions for disability-related expenses, such as medical or attendant-care expenses, are applicable to the entire range of HUD housing programs.

Earned Income Disregards. In implementing the Quality Housing and Work Responsibility Act of 1998, HUD instituted a grace period during which the new income of individuals with disabilities, who begin working after having been unemployed or receiving certain public benefits, is excluded from the calculation of their rental payments for public housing.

For the first year, this important incentive for employment is a full disregard of earned income, phasing down to a fifty-percent disregard in the second year. Eligible families include those with a person with a disability who have been unemployed for 1 or more years or been participating in a job training/self sufficiency program, or those that have received TANF within the past 6 months.

Currently, this incentive applies only to HUD's public housing program, but the new regulation will extend the incentive, as it applies to individuals with disabilities, to tenant-based Section 8 housing vouchers, the HOME program, the Housing Opportunities for People with AIDS program, and the Supportive Housing for the Homeless program. The Administration will also work with Congress to ensure that this earned income disregard applies to the few remaining HUD programs not covered by the regulation. The Administration currently is reviewing the necessary legislative changes and will submit the requisite changes to the Congress shortly.

Deductions for disability-related expenses. The regulation clarifies the applicability of deductions for disability-related expenses, including medical expenses and attendant care expenses. This rule will clarify that these deductions apply not just to public housing and Section 8 rental housing, but also to a broad range of HUD housing assistance, including the HOME Investment Partnership Program (HOME Program), the Section 202 Supportive Housing for the Elderly, and Section 811 Supportive Housing for Persons with Disabilities.

An important subgroup of the disabled who will benefit from these actions are people with disabilities homeless who, with these work incentives and other assistance, can be supported in moving toward self-sufficiency

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