ADA Information: Olmstead Update
UCP Commends Bush Administration Preliminary Olmstead Report
UCP comments on President Bush's Administration's preliminary report on federal implementation of the Supreme Court's 1999 Olmstead decree.
January 25, 2002
The Honorable Tommy Thompson
Secretary of Health and Human Services
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Washington, D.C. 20201-0004
Dear Secretary Thompson:
UCP, one of the nation's largest non-profit disability organizations, commends you for releasing the Administration’s preliminary report on federal implementation of the Supreme Court’s 1999 Olmstead decree. But we would caution that the report’s broadly outlined recommendations require further detail and assurances of adequate funding. As you know, the report, “Delivering on the Promise,” was presented to the President by a consortium of ten federal agencies charged with developing a plan to expedite federal activities in support of Olmstead, which requires people with disabilities to receive services in community-based rather than institutional settings when appropriate.
UCP is pleased with the general tone of the report’s recommendations, which were based in part on extensive public hearings. For example, it is helpful that the Department of Health and Human Services proposes to establish a Medicaid Community Services Task Force, an Office on Disability and Community Integration, and a demonstration testing the effect of health insurance coverage as a way to reduce turnover among direct-support attendants.
However, we are concerned about adequate funding for these initiatives. And, we are very concerned the report does not include a focus on addressing the severe shortage and inadequate compensation of Personal Attendant workers through the Medicaid reimbursement system. The critical shortage of staff to assist people who need help performing daily activities, such as eating and dressing, is the major barrier preventing people with disabilities from living in the community. In the Olmstead decision, the Supreme Court mandated that such barriers be eliminated.
The reason for this shortage is that Personal Attendant pay averages only $7.67 an hour nationwide, and it is this low because Medicaid –- which covers the majority of Personal Attendants service costs -- reimburses so poorly. Some state Medicaid programs reimburse Personal Attendant agencies for as little as $5.24 an hour, and that amount is supposed to cover not only wages but also administrative costs, such as staff recruitment, training and liability insurance. As a result, attendants are often paid less than entry-level fast-food workers, even though attendant jobs are physically and mentally more demanding. Service providers and individuals with disabilities cannot recruit nor retain the work force that is essential to community integration. The shortage in Personal Attendants is a real crisis. Increased Medicaid reimbursement rates for direct care services is the answer. The U.S. Department of Labor estimates 100,000 additional community attendants will be needed by the Year 2006, yet even now there are high vacancy rates in these positions. As a result of the overall personnel shortage, many people with disabilities are forced to live in institutions, which costs far more than adequate Medicaid reimbursement for Personal Attendant services.
Notwithstanding our concerns about the direct care personnel crisis, we appreciate the Administration’s effort to provide a wide-ranging proposal for implementing Olmstead, and we look forward to working with the Administration and its agencies to obtain the legislation, regulations and funding needed to make it a reality. The report is a good beginning, but federal financial commitment is necessary to fulfill the promise to implement Olmstead.
Sincerely,
Kirsten A. Nyrop
Executive Director
cc: Jennifer Sheehy, Executive Office of the President