Among the many changes brought about by the Affordable Care Act is one that may move forward some goals many people with disabilities have long considered crucial: greater dignity, privacy and independence. For states that currently have Medicaid waivers for home and community-based services, a provision of the ACA (sometimes called “Obamacare”) called the Community First Choice Option provides federal matching funds to make housing for people with disabilities much more amenable to full integration in society.

A new Medicaid rule about the Community First Choice Option is about to be published, and its goal is to refocus home and community-based services promoting personal autonomy and full incorporation into society.

“People with disabilities and older adults have a right to live, work and participate in the greater community,” says the secretary of Health and Human Services. Part of what Community First Choice does is to require that home or community-based services through Medicaid use a “person-centered” planning process, meaning that the individual’s preferences and specific needs must be addressed.

Moreover, Medicaid officials have been hearing for years that much of the housing provided for people with disabilities is not very home-like. For example, some so-called community-based housing was simply built on the same grounds where institutions formerly stood.

Under the new rule, Medicaid will require such housing to meet much stricter requirements. It must allow residents full access to the community and be evaluated based on the desired outcome. Nursing homes and institutions will not qualify.

Homes for people with disabilities will now be obliged to provide the greatest degree of privacy and freedom possible, including the right to make independent decisions about their daily activities, their home environment and interactions with others. Impressively, the rule specifically applies to people with intellectual disabilities.

States with existing Medicaid waivers for home or community-based services are expected to create transition plans and work to meet the new requirements as soon as possible.

Society’s attitudes toward people with physical and mental disabilities have come a long way. The idea that each individual is entitled to live as full and self-directed a life as possible has been a long time coming.

Source: Disability Scoop, “New Medicaid Waiver Rules Set To Take Effect,” Michelle Diament, Jan. 10, 2014