Thousands of people with disabilities nationwide live in nursing homes, care facilities, and other institutions — but it doesn’t have to be that way. With the right medical and personal supports, people with disabilities can live on our own with agency over our lives. Independent living saves money, builds equality, and gives us freedom into the world.
The Affordable Care Act is incredibly important for independent living, and provides two vital programs to support the freedom of people with disabilities. The first program, Money Follows the Person, already existed, but Obamacare provided more funding until 2016 and beyond. The second program, the Community First Choice Option, was created under the Affordable Care Act and went into effect in 2012. Both MFP and CFC fund home and community-based services such as personal attendant care so that people can live in their own homes. If the Affordable Care Act goes away and these programs disappear, many people with disabilities may end up returning to nursing homes and institutions. This won’t just take away our independence, it will take away our freedom.
Money Follows the Person
Money Follows the Person is a federal initiative that was created through the Deficit Reduction Act of 2005 and provides grant funding to states to start MFP programs. These programs expand access to home and community-based services such as personal attendant care and transportation so that individuals with disabilities can move out of institutions and into the community. The Deficit Reduction Act also helped to change state laws so that Medicaid funding can better support people independently — so these work together to really change lives.
The ACA expanded eligibility for MFP funds to even more individuals, especially people who have been in institutions for less than six months. The ACA also extended the program through 2016 at a rate of $450 million per year. Although that means the main funding ran out by this year, states that started a program after 2012 could get funding for a full four years after, and any leftover money from MFP yearly grants could be spent in future years. That means that some states still have MFP programs and may for several more years.
Community First Choice
The Community First Choice program was established by the Affordable Care Act, and is still going on today. This program allows states to establish “Community First Choice Options” for people with disabilities and elderly individuals, so they can live in the community instead of institutions. CFCOs pay for personal attendant care and sometimes also for immediate costs of moving out of institutions, such as a first month’s rent. Under these plans, people with disabilities can be “self-directed” in how they hire, manage, and fire their personal attendants. States can also choose to help people with disabilities when they transition into the community.
As of late 2016, only eight states had CFCO programs, possibly because states still have to pitch in some cash into the program’s “matching funds” requirement. But the states with programs are some of the largest in the country — including Texas, New York and California — and together, they make up over one-third of the national population. The program has already helped thousands of Americans move out of institutions, with the potential for thousands more if the ACA continues to exist. But while the CFC doesn’t have an end date like MFP, it risks disappearing if the Affordable Care Act is taken away.
When Independence Disappears
Many states have programs such as California’s In-Home Supportive Services that provide money for personal attendant care and other independent living services. Money Follows the Person and Community First Choice programs go beyond IHSS, especially targeting people with disabilities who reside in institutions to help them live on their own in community settings. Funding is vital for these programs, though, and Obamacare helps make them possible. The Affordable Care Act expanded and extended the powerful services provided by MFP — and Congress needs to continue its work in supporting states’ programs. Obamacare also started CFC and continues to provide matching funds to partner states. But if the Affordable Care Act goes away, thousands of Americans risk losing the services that allow them to live on their own. It would be an attack to independent living, and a hit to disability rights nationwide.