News Analysis: The Obama Administration and Community Choice

Brooklyn lawyer and disability advocate, Tk Small, crossed party lines in 2008 to vote for President Obama after he supported the Community Choice Act. “I was proud that he had made it so publicly part of his campaign,” Small says. The legislation would have removed the institutional bias and established a community-based care system, but Small was angered when commitments to the CCA were abandoned to pass the Affordable Health Care Act. “We shouldn’t force people to live in a system that infantilizes them, takes away their liberty and forces them to do things that are dysfunctional just to maintain eligibility for Medicaid,” he says.

Small blames the CCA demise on a broken political system. But the AHCA does not ignore community-based options. It created the Community First Choice Option, which establishes a consumer-driven care model in agreement with the Olmstead decision. Community care must be provided and waiting lists must be eliminated. While the program remains optional, states implementing it will receive six percent in federal matching funds.

Small says the community choice option is a waste of time. Because it’s optional, he says implementation attempts will lead to a nationwide ground fight. He isn’t worried about states like New York implementing it, but doesn’t have faith in states like Alabama, Texas and Florida to follow suit.

Henry Claypool, AAPD Vice President for Policy and former senior disability policy advisor for the Department of Health and Human Services, says the CCA wasn’t pursued because of its expense, but important progress has been made nonetheless. According to Claypool, the AHCA encourages states to move away from institutional care, gives financial incentives to states and provides $2.25 billion in additional funding for Money Follows the Person.

Still, Claypool understands the frustrations that advocates have. “I think being dissatisfied is not an uncommon experience for advocates,” he says. “If you were satisfied, that would imply that your work was done.”
Claypool is optimistic that states will embrace the community choice option once they take a deeper look into it. The AHCA may not be perfect, he says, but “it does address the interests of people who rely on Medicaid for home and community based services.”

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