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Healthcare Reform Legislation Needs the CCA!
NCIL needs you to get involved!


As we reported in the action alert last week, NCIL has been busy educating its members and members of Congress about the importance of including Long-Term Care Reforms in the Health Care Reform legislation. The legislative process continues to happen at a furious pace, and now the U.S. House of Representatives has taken up the legislation by proposing a “tri-committee” draft proposal of legislation to overhaul the nation’s healthcare system.

What‘s going on?

The House of Representatives Committees on Education and Labor, Energy and Commerce, and Ways and Means came together to release an 850-page draft of legislation late last week. What was missing from the House draft was language to end the institutional bias in Medicaid, which is found in the Community Choice Act (CCA). Hearings on the proposal began this week.

NCIL wants to be very clear. We continue to fully support the language of the CCA in the healthcare reform legislation, as well as the legislation as a stand-alone bill, should it not be included in healthcare reform. That said, NCIL is looking at alternatives that would be acceptable to people with disabilities and would not leave us with the status quo should Congress fail to include the language of the CCA. Those alternatives are being offered by Congressman Danny Davis (D-IL). Congressman Davis, the House Sponsor of the Community Choice Act legislation in the House of Representatives, is circulating a letter amongst his House colleagues to get their support to include the language of the CCA in healthcare reform. Congressman Davis first stresses, as NCIL has all along, that the language of the CCA must be included in the healthcare legislation. If getting the CCA in the healthcare legislation is not possible, Congressman Davis then offers the following suggestions:


  • Conduct a multi-state demonstration plan targeting states that lack home and community based services, or that have moderate capacity to provide these services to evaluate the costs and savings for these states. This means that a state which would choose to implement home and community-based services as a mandated service offered in Medicaid would be the proof advocates have long wished to show policy-makers that HCBS is cost-effective, as well as the right thing to do. This would finally provide real choices to people with disabilities who do not have the right to live in the community because their Medicaid will not cover HCBS.


  • Provide the provisions of the CCA as a state option under Medicaid. This means that the federal law will finally provide an option for all states to offer home and community based services as a basic benefit in their state Medicaid Plan. NCIL must stress that this is an optional benefit to states, but if a state selects this as an option, the HCBS benefit becomes a mandatory option for anyone who is eligible for Medicaid. This option would finally create an opportunity for all 50 states to offer this benefit as a part of their Medicaid Plan, much like dental services, durable medical equipment or personal care services are already an option for states, and the benefit could not be capped to a certain number or type of Medicaid-eligible citizens. Local Advocates in states would have a tangible Medicaid benefit to push their states to offer.



What is the Message?

Healthcare reform is not truly reform for millions of Americans if we do not include the language of the CCA! If this is not going to be possible, I would recommend two approaches to address the institutional bias in Medicaid. Those approaches would be to (1) Conduct a multi-state demonstration plan targeting states that lack home and community based services, or that have moderate capacity to provide these services to evaluate the costs and savings for these states, and (2) Provide the provisions of the CCA as a state option under Medicaid.

What do I do?

Take a look at the three committees working on healthcare reform in the House of Representatives (below). See if your Representative is on the Energy and Commerce Committee, the Education and Labor Committee, or the Ways and Means Committee. If they are, tell them that as a member of that committee, they have an influential role in the healthcare reform process, and people with disabilities on Medicaid cannot wait any longer for the right to live outside of a nursing home or other institution.

***If you live in California, contact Congressman Henry Waxman THIS WEEK. Tell him that as a California resident, you strongly support language in the healthcare legislation that would end the institutional bias in Medicaid. Tell Congressman Waxman that as the Chairman of the Energy and Commerce Committee, he has an influential role in the healthcare reform process.

I need more information!



  • To learn more about the CCA, the language we want included in the healthcare legislation, review the NCIL Legislative and Advocacy Policy Priorities (in PDF or Text Only).


  • See if your Representative is on the Education and Labor Committee, the Energy and Commerce Committee, or the Ways and Means Committee


  • Congressman Waxman’s Contact Information


If you have questions about healthcare reform, our message, or just not sure what’s happening here, please contact Jason Beloungy, NCIL Policy Analyst, at 202-207-0334 (toll-free 1-877-525-3400), ext: 1008, or e-mail Jason at: jason@ncil.org

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