• Enabling people with disabilities to live in their community. HHS is working with states to uphold the Supreme Court's Olmstead ruling to enable as many people with disabilities as possible to live in their community. In the 1999 case, the U.S. Supreme Court ruled that under the ADA, unjustifiable institutionalization of a person with a disability who can live in the community is discrimination. In January 2000, HHS sent guidance to state Medicaid directors to encourage cooperative efforts with leaders in the disability community to help states develop plans to enable people with disabilities to live in the most integrated setting that is possible given their state's resources. Additional guidance is being sent to state Medicaid directors this month providing further clarification on the flexibility states have to provide services in integrated settings under the Medicaid program. These efforts continue the progress made through the home and community-based Medicaid waivers that enable many people with disabilities to receive Medicaid-covered health care assistance to help them live in their communities.

• Helping people with disabilities become self-supporting without losing health coverage through Medicaid. HHS is implementing the Ticket to Work and Work Incentives Improvement Act of 1999. The department is working with state Medicaid directors to enable people with disabilities who earn too much money to qualify for Medicaid to buy into the program, or to enable states to extend the income limits of Medicaid programs for people with disabilities. Beginning in fiscal year 2001 and continuing for the next five years, HHS is offering states federal Medicaid infrastructure grants of at least $625,000 to assist states with designing and implementing expanded Medicaid eligibility options for people with disabilities. The total award over five years will be $150 million.

• Enabling people with disabilities to control their own health care and supporting services. In 1996, HHS and the Robert Wood Johnson Foundation announced state grants to support "Cash and Counseling" demonstration projects to provide people with disabilities more control over the long-term care supports they receive. These experiments now underway in Arkansas, New Jersey and Florida offer cash allowances and supportive services to enable people with disabilities to purchase the care services they feel will best meet their needs. In addition, HHS is partnering with state agencies and consumer groups in the Resource Network on Home and Community Based Services to drive the expansion of quality, consumer-directed and cost-effective services in home and community based settings.

• Targeting health goals for Americans with disabilities. Healthy People 2010, which establishes national goals to improve America's health, includes specific targets for people with disabilities, including reducing the number of people with disabilities who report feelings of depression that prevent them from being active, and increasing the proportion of adults with disabilities who participate in social activities. Healthy People 2010 also aims at preventing disability.

• Supporting children with special health care needs to achieve greater success in adulthood. In 1995, HRSA's Maternal and Child Health Bureau began funding the "Healthy and Ready to Work" program, designed to help children with special health care needs to successfully make the transition to adult life in the community. Some 6,000 youths with special health needs benefit from $2.5 million in program grants to help provide training and support in promoting self-determination and leadership skills.

• Helping older Americans with disabilities. Administration on Aging programs serve older Americans with disabilities through state and area agencies on aging. In fiscal year 2001, AoA is requesting $125 million to enable state and area agencies on aging to help caregivers of older persons with disabilities by providing support services such as support groups, respite and adult day care. This year, AoA has awarded funds to the National Center for Senior Housing Research to develop innovative solutions to address mobility and other housing issues for older Americans with limitations in physical functioning. AoA also administers the Alzheimer's Disease Demonstration Grant to States Program to develop models for serving persons with Alzheimer's disease and their families.

• Providing assistance to people with developmental disabilities. Administration on Developmental Disabilities programs increase independence and provide community supports for people with disabilities that begin early in life. ADD funds three state-based grant programs that address issues such as diagnosis, early intervention, prevention of secondary disabilities, assistive technology, education, community supports, housing, transportation, self-determination and employment.

• Special efforts to help Americans with mental illness. HHS programs and initiatives focus on greater diagnosis and treatment of mental illness. In 1999, Surgeon General David Satcher issued the report, "Mental Health: A Report of the Surgeon General," to provide an overview of the status of mental health treatment and ways to improve the quality of mental health care in the United States. In addition, HHS' Substance Abuse and Mental Health Services Administration is focusing on improving the employment prospects of those living with psychiatric disabilities. The agency is currently completing the largest study ever conducted of programs to help people with mental illness to find and keep jobs. The study, Employment Intervention Demonstration Program, will be highlighted at the National Employment Summit next summer.

• Providing funding and leadership in research. The National Institutes of Health support and conduct research that lays the groundwork for understanding causes of disability and for developing innovative new treatments or assistance for people with disabilities. For example, in the past 10 years NIH-sponsored research has discovered genes related to blindness caused by glaucoma and macular degeneration and has demonstrated the first effective treatment to significantly reduce the disability of patients shortly after a spinal cord injury. In addition, the National Institute on Deafness and Other Communication Disorders is collaborating with the Department of Veterans Affairs and with NASA to support the development of better hearing aids.

  Over the past decade, the Agency for Healthcare Research and Quality (AHRQ) has conducted research to help policymakers plan for meeting the health needs of people with disabilities by examining their access to and use of health services, including Medicaid and managed care. AHRQ has used this information to host workshops to educate state health officials and to conduct outreach to people with disabilities to provide them with the information they need to make their own health care coverage decisions.

  The Office of Disability, Aging and Long-Term Care Policy supports and conducts research and analysis of HHS policies and programs that support the independence, health and long-term care of people with disabilities. Over the past 10 years, the office has been responsible for policy coordination and research related to nursing home and community-based services, informal caregiving, the integration of acute and long-term care, Medicare post-acute services and home care, managed care for people with disabilities, long-term rehabilitation services, childhood disability and the link between employment and health policies.

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