Summary: Comments are provided on H.R. 6194. If enacted, H.R. 6194, the Medicaid Community Care Act of 1980, would amend title XIX of the Social Security Act to provide for comprehensive assessments and community-based services under Medicaid. It is intended to redress inadequacies in the Medicaid system which encourage expensive and often unnecessary institutionalization. The mechanisms established the proposed legislation should resolve many of these problems by assuring a more efficient allocation of medicaid dollars in long-term care, and offering many elderly and disabled individuals and their families the option of receiving services in their own homes or community in lieu of having to enter a nursing home. GAO found that there was no universally accepted method of delivering and financing long-term care services. However, certain project elements are integral to any effort if avoidable nursing home utilization is to be prevented. These include: (1) a nursing home gate-keeping mechanism; (2) a comprehensive needs assessment; a mechanism for planning, coordinating and monitoring community-based services; (3) a simple comprehensive source of funding; and (4) control over costs and utilization. The focus on maximizing State discretion is also apparent in the bill's option which enables States to voluntarily elect to participate in the program. If the State does participate, it is then eligible for an increase in the Federal Medicaid match for community-based services. This increased matching should provide the financial support many States have needed to expand their delivery of long-term care services. The bill should also provide an opportunity to gain experience and answers to questions in long-term care which presently have not been answerable under the traditional approach of demonstration projects and research grants. A comprehensive social or medical assessment is provided for each individual eligible or applying for assistance under the State plan who is likely to be in need of long-term skilled nursing facility or intermediate care facility services. Voluntary assessments should be given to all other nursing home applicants. Revisions should be made to assure that individuals who are eligible for Medicaid if they enter a nursing home would also be eligible outside of an institution. Private pay individuals should be considered eligible to participate in this program, and services under the plan should be made available to them on a reimbursable basis.
