“MiCASSA no longer exists.” Well that’s a hell of an e-mail to read before you’ve had your first cup of coffee.

Where’d it go? Did a congressional page misplace it, perhaps using it as a book mark in a Manga novel? Did a clumsy legislator drop it on the floor of the House, shattering it to bits? WHO LOST MY MiCASSA?

Oh man … MiCASSA no longer exists … this is awful. In my mind, MiCASSA -- which stands for the Medicaid Community Attendant Services and Supports Act -- is as significant as the Americans with Disabilities Act. What sense does it make to have buildings and sidewalks made accessible if people can’t get out of bed to enjoy them?

As the coffee slowly took effect I read further. Ah … the e-mail from ADAPT spokesperson Marsha Katz was just a gentle reminder about MiCASSA’s name change: “The legislation introduced this year is the Community Choice Act of 2007, S799."

So I called up Katz, who, when not handling the media for ADAPT, is project director for the University of Montana Rural Institute and also serves on the Social Security Advisory Board, and asked her why the name changed. “That came from Congress, from the sponsors,” says Katz. “It’s a change that makes a lot of sense -- this is what the bill’s all about, giving people the choice to remain in the community.”

Anything else change besides the name? Yes, especially one big wonderful addition: “It’s more responsive to people who use vents and live in states that don’t want to serve them in the community.”

So far in the 21st century we have Money Follows the Person, which helps states learn how to get folks out of institutions who don’t want to be there. And we’ve had a series of Real Choice systems change grants, and more states than ever are rebalancing their long-term care systems to give the people what they want – which is usually the freedom to stay where they are and not have to trade in a house for a bed.

“We didn’t get this bill passed yet, but it’s only part of all we’ve accomplished,” says Katz about MiCASS … er, I mean the Community Choice Act. “We have demonstrated the efficacy of choice. And that comes after the fact that it’s simply the right thing to do.”

The efficacy of choice. Catchy phrase. Um, what’s it mean?

“On average the cost of community care is typically less, fewer dollars than for bricks and mortar,” says Katz. And we need to remember this is averaging everyone who uses personal assistance together, since some people require more hours than others -- and how people use their hours is strictly their own business. “I remember meeting with a woman who uses a power chair and all she wanted was to sit on her new couch. This meant she needed to have someone help her move to the couch so she could enjoy it sometimes,” says Katz. “People don’t ask for a lot. They’re not asking for the moon.”   

Why is it that some people actually do get a few hours of skilled care everyday? Canada has flaws but every quad I know gets 8 hours a day with an Aide, some, those who can prove a need actually have live-in caregivers.

Why is it that we are so willing in this country to hamper people's abilities to live self-sufficiently? We won't fund the equipment or the advanced schooling people need to work, but we will fund nursing home care for young adults with disabilities that gives them little opportunity to ever become self-sufficient? We force people into full-time care when all they need is a few hours of skilled care a day and a lot of other non skilled hours. MiCassa or whatever it is called this week is one the things we desperately need to end the forced poverty the majority of people with disabilities live in - in this country.

MiCassa is not just for quads - it's for anyone with a disability. Canada has its share of problems, too. "Beyond Ontario, individualized funding projects were pioneered in Alberta and are reported in early stages in Saskatchewan, Alberta and Atlantic Canada. But British Columbia seems to be most active and most advanced."http://www.ont-autism.uoguelph.ca/STRATEGIES6.shtml No program in Manitoba or Quebec or any of the territories? And "individualized or direct funding and has been available to people with physical disabilities exclusively in the past. Families would like that extended to people with developmental disabilities as well. When funding is attached to a person and not an institution or placement, people can choose the way they wish to live "http://www.family-alliance.com/ltc_letters0702.html

Dude - Not to be a typical dumb American, but how is PAS paid for in Canada? Is it part of the health care system? Here in the U.S., how much you get depends on which state you live in - not very efficient. Is it that way in Canada? Also, in the states, often you have to be poor to get a decent amount of hours. In Canada, can a person enjoy his/her pay check or is it whittled down to cover services (the crip tax)?