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Supporting Community Living

The Affordable Care Act helps all Americans, including people with disabilities and seniors, live at home with the supports they need, rather than in nursing homes or other institutions, and participate in communities that value their contributions.

After a traumatic brain injury as an infant, Quentin Hammond lived in a nursing home for the first six years of his life. At the nursing home, the caregivers viewed him as blind and vegetative, and not able to engage. However, thanks to a program supporting community living, Quentin’s mother Teresa, was able to bring him home where he now receives the right mix of services and supports. Quentin has benefited from living with the love and support of his mother and little brother, who calls Quentin his best friend.  Much to the contrary of his caregivers’ views in the nursing home, today Quentin can see, engages with others, and attends school. As Teresa said, “it’s been like a 360 turn, he is a different person.” 

The Obama Administration has long been committed to helping all Americans, including people with disabilities and seniors, live at home with the supports they need, rather than in nursing homes or other institutions, and participate in communities that value their contributions. The Affordable Care Act has been critical in those efforts, providing many new resources and supports.

Today, the Department of Health and Human Services (HHS) released the latest step towards expanding community living with the final rule creating the Community First Choice (CFC) Option. Thanks to the new health care law, CFC gives States additional resources to make community living a first choice, and leave nursing homes and institutions as a fall back option.  Under CFC, States can receive a six percentage point increase in federal matching funds for providing community-based attendant services and supports to people with Medicaid.

HHS also announced the first 16 organizations that will participate in the Independence At Home Demonstration program, which encourages primary care practices to provide home-based care to chronically ill Medicare patients.

Here are some other ways the Administration is helping support community living:

  • The new Administration for Community Living is bringing together key HHS organizations and offices dedicated to improving the lives of those with functional support needs into one coordinated, focused and stronger entity. This new agency will work on increasing access to community supports and achieving full community participation for people with disabilities and seniors. 
  • The “Money Follows the Person” program – which helped Quentin succeed at home – makes it easier for Americans with a disability to live independently.  In Money Follows the Person, the Medicaid funds that supported the nursing home services “follow” the person and support the long-term services in their home, so they can choose when and what they eat, when to go to bed, and when they visit with their family and friends. Thanks to the new health care law, the program has expanded to 43 States and helped 12,000 individuals move out of institutions and back into their communities. Already 13 States received $45 million in 2011, and will receive more than $621 million through 2016, to help an expected 13,000 additional people.
  • Thanks to the new health care law, new rules are making it easier for States to provide home and community based services in the Medicaid program through home-and-community based (HCBS) waivers.  Previously, these waivers required States to serve one target group per waiver, but now States can target multiple groups, including seniors, persons with developmental disabilities or mental illnesses.  This reduces administrative challenges delaying opportunities for persons with disabilities to either remain in or transition to community living situations.
  • Under the Balancing Incentive Program, $3 billion in enhanced Medicaid matching funds are available to States to increase access to long-term services and supports in home and community-based settings rather than institutions. In March 2012, New Hampshire and Maryland were the first States to receive this new funding. 
  • Through a partnership between HHS and the Department of Housing and Urban Development, new housing support is now available to help non-elderly persons with disabilities live productive, independent lives in their communities rather than in institutional settings.  HUD is offering approximately $40 million to public housing authorities across the country to fund approximately 5,300 Housing Choice Vouchers for non-elderly persons with disabilities, allowing them to live independently. This includes vouchers to help nearly 1,000 non-elderly Americans with disabilities leave nursing homes or other healthcare facilities to live independently.

Learn more about how the Affordable Care Act is helping Americans living with disabilities here.

Henry Claypool is Senior Advisor for Disability Policy to the HHS Secretary, and Principal Deputy Administrator of the Administration for Community Living.