Opposition to MiCASSA

The Voice of the Retarded criticism is shallow and unfounded.

By Tim Wheat

MiCASSA is entering a new legislative year and Americans will be examining Medicaid reform and long-term care options. One group that opposes MiCASSA and Money Follows the Person (MFP) legislation is the Voice of the Retarded. 

Although the Voice of the Retarded claims to “…advocate for a full range of quality residential options and services,” they appear to me to be a grassroots front for institutions. In fact, the Nursing Home Lobby was the largest sponsor of Voice of the Retarded’s 2004 Annual Meeting. The Voice of the Retarded claims to be supported by “thousands of member contributions” yet does not assert their membership on their website and a photo of the 2004 Annual Meeting shows only five people. 

The Voice of the Retarded uses its website to disapprove of MiCASSA. Despite their real size and intensions, I think that by examining what the Voice of the Retarded has to say about MiCASSA you will find that they actually have no reasonable criticism. I have chosen not to ignore them as shills and crackpots because with just a little analysis what the Voice of the Retarded has to say about MiCASSA, I believe you will see the reality of MiCASSA and the advantages of Medicaid reform. 

From the first page of the Voice of the Retarded website they list an essay entitled: “The Myth of an ‘Institutional Bias’ in Medicaid for Persons with Mental Retardation and Developmental Disabilities.” One of the strongest promotions of MiCASSA is to end the Medicaid bias. Because public Medicaid funds are required to pay institutions, many people with disabilities do not have the choice of more desirable and cost-effective community services. By suggesting that no institutional bias exists, the Voice of the Retarded takes away a main advantage of MiCASSA.

One does not have to read far; however, to see that the title of the essay is misleading. The unnamed author, in the first and second sentences points out that there is an institutional bias in Medicaid spending. The author then attempts to make the point that for the narrow population of “persons with mental retardation and developmental disabilities,” Medicaid spending is relatively equal for institutions and community services. 

Of course the Medicaid bias is that US states are required to provide expensive institutional care, while desirable home and community-based choices are optional Medicaid programs. But, examine the bias in Medicaid spending also. The state of Tennessee, for example, spends $149.00 on institutions for each buck spend on community alternatives. There is clearly an institutional bias in both Medicaid policy and spending.

Please examine the numbers provided in the Voice of the Retarded essay more closely. Not only do they state that 55% of funding for persons with mental retardation and developmental disabilities goes to home and community options, but this represents 74% of this limited population. Nearly half (45%) of the funds are spent on the 26% of “persons with mental retardation and developmental disabilities” that are institutionalized.

The essay attempts to suggest that for “persons with mental retardation and developmental disabilities” there is no spending bias. The Voice of the Retarded’s own numbers; however, show that home and community based services are less than half the cost to taxpayers. The bias is that every US state must provide expensive institutional care to get the federal matching Medicaid funds, efficient and effective home and community-based services are optional Medicaid programs. Governor Bredesen of Tennessee, like many other states, is looking to drop optional Medicaid services to over a quarter of a million citizens to save money. MiCASSA would end the bias and provide real choices for people with disabilities.

Remember, MiCASSA and MFP provide choices to Americans; they do not call for any cuts to institutional options. The Voice of the Retarded extrapolates that institutional “…care may become uneconomical and extinct,…” as Americans naturally choose more desirable community alternatives. 

The Voice of the Retarded seems to push a “corporate welfare” model to keep public funds flowing into economically untenable institutions. Because the Voice of the Retarded admits that an institutional bias exists for the global system, they are asking the taxpayer to fund inappropriate institutionalization for the “vast majority” of Medicaid recipients for the single goal of ensuring public money props up the expensive choice but not the alternative. 

If institutionalization were actually effective and necessary, then choice and market forces would work to make facilities a reasonable alternative to home and community services; the Voice of the Retarded would support MiCASSA, because people would naturally choose institutions, providing them with adequate public funding. Of course, institutions are inefficient and undesirable. Medicaid reform is necessary to help bring people with disabilities out of the shadows and into the community.

The Voice of the Retarded also has a position tract on why they oppose MiCASSA, which seems to only suggest that they oppose MiCASSA because the cost would take away from institutional funding. I invite you to read the untitled piece on why they oppose MiCASSA. I find it to be mostly incoherent and an attempt to use fear mongering in opposition to real choice. The article uses the old CBO cost estimate to sensationalize the cost and it asserts “quality and availability will suffer,” with no reasoning at all. 

In promoting MiCASSA you may run across someone that has been misinformed by the Voice of the Retarded website. I think the best tactic is to have them read what the Voice of the Retarded has to say with a critical eye.

 - Tim Wheat