June 5, 2003

I thank the Chairman for holding today’s hearing on consumer-directed personal care services in Medicaid. Increasing community-based care options for individuals living with disabilities is a critically important goal that we must work with states to achieve. Expanding access to personal attendant services and improving control over such services -- the subject of this hearing -- is an important element for community living options to work successfully.

Last month, I, along with a number of members of this Committee, introduced H.R. 2000, the "Strengthening Our States Act." Among other provisions, the legislation encourages states to expand personal care services and supports under Medicaid and helps states expand community-based living options. It provides permanent enhanced federal funding for states to provide personal attendant services and supports in Medicaid and enhanced federal funding for all home- and community-based waivers. States do not have the budgetary means to serve all individuals who would choose community-based care, so they need the partnership of the Federal Government under the Medicaid program.

For this reason, I am particularly concerned with proposals coming out of the Bush Administration on so-called "Medicaid reform." The President would have us believe that severing or limiting the state-federal relationship under Medicaid and shifting the financial burden onto the states can help the families who depend on these programs. But the exact opposite will come to pass, particularly for the services we are discussing today. The assistance and funding for community-based and consumer-directed services that are there will wither -- leaving individuals living with disabilities in a dire situation and forcing many back into institutions or leaving them with no care at all.

One important point to consider is that the consumer-directed care program has been very successful, but there is no inherent reason that vouchers are required in order to give families more control over personal care services. States could be given incentives to improve consumer choice and control -- without capping funding for families -- so that families are guaranteed an adequate level of service which is not subject to future arbitrary budgetary cost-cutting measures. In addition, even if people were given the ability to "manage" their money for personal care services, this does not mean that people with disabilities should be given limited dollars to manage all their health care needs. As many will testify today, it is much easier to "manage" certain predictable daily tasks than it is to predict how to manage the amount of care an individual with disabilities will need when they are sick.

I look forward to the testimony of all of the witnesses today on the successes of the Cash and Counseling program and how we might work here in Congress to encourage expansion of this model so that it is not limited to only a few states and only a few populations. We want to ensure that all individuals living with disabilities can choose to receive the benefit of directing their own personal care services. But we also want to ensure they have adequate protections so they do not have to worry about whether the money will be there from week to week.

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