On this ADA Anniversary, Congress Should Pass the Better Care Better Jobs Act
By: Jennifer Mathis
During this anniversary of the Americans with Disabilities Act (ADA), disability advocates call on Congress to pass the Better Care Better Jobs Act, which would make a greater federal investment in Medicaid home and community-based services (HCBS) for people with disabilities. This legislation would bring a much-needed expansion of HCBS by authorizing a 10% increase in federal Medicaid reimbursement for these services.
This past Monday marked the 31st anniversary of the ADA, landmark civil rights legislation that prohibits discrimination based on disability. Congress passed this landmark civil rights law in 1990 with overwhelming bipartisan support. The ADA has had an enormous impact on the lives of people with disabilities, opening doors to participate in virtually all aspects of American life after decades of isolation, segregation, and discriminatory treatment. Despite this progress, a great deal remains to be done in order to fulfill the ADA’s goals of equal opportunity, full participation, independent living, and economic self-sufficiency.
One of the core requirements of the ADA is its “integration mandate.” It requires states and local governments to administer services to people with disabilities in the most integrated setting appropriate. The ADA’s integration mandate and the Supreme Court’s Olmstead decision have enabled many thousands of people with disabilities to live, work, and receive services in their own homes and communities. Yet segregation still persists in our systems of serving people with disabilities.
The COVID-19 pandemic starkly demonstrated the risks of relying on institutions and other congregate care facilities to serve people with disabilities. While individuals in long-term care facilities comprised less than 1% of the country’s population and accounted for only 4% of the country’s COVID-19 cases, they accounted for nearly one third of the country’s COVID-19 deaths.
It is time for states and local governments to invest more resources into developing their community service systems. Please contact your members of Congress and ask them to support the Better Care Better Jobs Act. This bill, introduced in both the Senate and the House, would increase by 10% the match that the federal government provides to states for Medicaid HCBS. The recently enacted American Rescue Plan Act provided a one-year 10% match for Medicaid HCBS to help states address needs related to COVID-19. The Better Care Better Jobs Act would extend that match into the future.
The Better Care Better Jobs Act would require states to meet particular conditions to receive the increased federal match, including among other things:
· expanding access to behavioral health services and coordination with employment, housing, and transportation supports;
· expanding coverage of personal care services;
· providing supports to family caregivers including peer support and paid family caregiving;
· expanding eligibility for or improving coverage under a Medicaid buy-in program;
· ensuring that payment rates are sufficient to ensure that covered services are available;
· ensuring that increased rates are passed on to direct care workers who provide the services;
· expanding opportunities for HCBS beneficiaries to direct their own care; and
· adopting core quality measures for HCBS set forth by the Department of Health and Human Services.
The Better Care Better Jobs Act would incentivize making home and community-based services available to many more people, build in mechanisms to improve the quality of these services, and expand the workforce that provides these services. Through these measures, the Better Care Better Jobs Act would afford new opportunities for millions of people with disabilities to receive services in their own homes and communities.
Congress should act quickly to pass this critical legislation. It should also ensure that the full amount of funding for this HCBS investment reflected in the President’s American Jobs Plan — $400 billion — is appropriated.
