Wes Clark.

1. Do you support the passage and full implementation of the Medicaid Community Attendant Services and Supports Act, MiCASSA?

YES. While the United States has become a world leader in promoting the civil rights of persons with disabilities, our nation has a long way to go to reform our benefits programs so they help achieve goals of civil rights laws like the ADA rather than undermine the ADA's purposes. Many people with disabilities need long-term assistance with their daily activities. But the Medicaid system that serves them was conceived more than thirty years ago, and it's showing its age. In contrast to the ADA with its goal of independent living, Medicaid is a system that devalues choice and says that government knows what is best for people with disabilities. Under this system, about 75% of funding goes toward institutional care - and only 25% for community-based services. I believe we've got the balance all wrong. 

I think that people who need long-term services and supports should be able to choose when and where they get them, and who provides them. Because unnecessary institutionalization is discrimination, plain and simple. Tearing families apart is just plain wrong. And taking people out of their communities is un-American, because inclusion is our greatest strength, and when we undermine that, we undermine America. That's why I'm going to stand up for MiCASSA - because I think it's time we empowered individuals, not institutions. I also believe that effective implementation of MiCASSA depends on enhancing the capacity of community-based organizations such as independent living centers to aid in the transition from institutional to community-based living. While we work for passage of MiCASSA I will therefore work with Congress to provide community-based organizations with the tools they need to make community-based living a reality, not just a policy.

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2. Do you support the passage of legislation that will implement the concept of Money Follows the Person that is included in S.1394?

YES. We need to take advantage of the ability of individual states to serve as laboratories for refining effective reforms for our benefits programs. I support the concept of individuals rather than institutions determining how our long-term care dollars are spent. By authorizing a demonstration project to explore the most effective approaches to implementing this concept, S.1394 will help us determine the policies we should be implementing on a national scale.

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3. Will you work with the states to assure they implement the Supreme Court's Olmstead decision so all people with disabilities, old and young, have the right to support services in the most integrated setting?

YES. 3a. What specific actions would you take?

The Olmstead decision framed the issue of long-term services and supports in civil rights terms. When a person with a significant disability is forced to live in a segregated, institutional setting because no alternative has been created by the State, that person is being relegated to a second-class life - frequently with little freedom, dignity or autonomy. That is wrong. As President, I will work with bipartisan leadership in the Congress and with governors to create stronger Federal incentives for States to provide meaningful choices in the community for all their citizens with disabilities of all ages. I believe that this policy will result in a higher quality of life for children, adults and seniors with disabilities and their families. It will also result in more cost-effective service delivery, more accountability from caregivers, and new workers for the labor market.

However, unless we make it a top priority to help alleviate the financial burdens that the states presently face, which are restricting their abilities to implement the Olmstead decision, we won't be giving the states and Congress all the tools they need to end the institutional bias. That's why I have proposed a $40 billion dollar state and local tax refund. By helping states' financial outlook we can more effectively empower them to collaborate in partnership with the federal government in implementing the Olmstead decision. Moreover, we cannot implement the Olmstead decision and increase home and community-based services unless there is an adequate supply of housing.

Presently, there is a severe shortage of housing that is safe, accessible, and affordable for people with disabilities. Improving our housing infrastructure includes increasing support for the Section 8 voucher program to broaden access for non-elderly persons with disabilities, as well as Section 811 for people with severe disabilities; increasing production of affordable housing; and providing incentives for the builders to adopt visitability in their design and construction.

4. Will you appoint a Secretary of Health and Human Services that will have a Community First philosophy and will review all Medicare and Medicaid policies with the intention of removing all policies that contribute to the institutional bias that exists in the current long term care system?

YES. I will appoint cabinet officials and sub-cabinet officials who will effectively implement my policy priorities, including a thorough review of Medicare and Medicaid policies that contribute to the institutional bias in our nation's long-term care system.

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5. Will you appoint a high level task force to review the funding of long term services and supports and make recommendations on concrete ways to reverse the institutional funding bias?

YES. Our nation will only make progress in ending the Medicaid institutional bias if we make it a real priority. This means bringing together representatives of all affected constituencies to identify solutions that maximize benefits for all concerned. That's why I will appoint a high-level task force to systematically review options and recommend specific steps, and then I'll work aggressively to implement the task force's proposals.

6. Will you support/develop long term service and support policies that enhance the consumer direction/self determination of personal attendant services by allowing persons to select, manage and dismiss attendants?

YES. Choice in our long-term care system will only be meaningful if it is implemented at the individual level where people with disabilities select, manage and dismiss their own attendants. I will charge my long-term care task force to include selection and management of attendants as one of the areas that needs to be examined and implement their recommendations.

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7. Will you support/develop long term service and support policies that will demedicalize personal attendant services by allowing physician/nurse assignment/delegation as well as tasks being defined as non medical?

YES. Given the escalating health care costs our nation faces, we need to be creative in identifying ways that we can reduce costs by utilizing non-medical personnel where medical training is not required. I believe personal attendant services is an area where we can give people with disabilities greater freedom in selecting the services they need while at the same time helping to minimize the costs of such services.

8. Will you support/develop long term service and support policies that will develop wage and benefit incentives so that there is a large pool of attendants available to meet the growing personal attendant service needs in this country? Currently you can make more money working in a fast food restaurant than as an attendant.

YES. We can't meet the goals of the ADA and implement the Olmstead decision if we don't focus on capacity-building so that there is a sufficient pool of attendants available to meet the demand for personal assistant services. I support identifying ways to increase wages and enhance benefits for attendants so that working as an attendant is more attractive. Personal attendants make it possible for many people with disabilities to live more independently. We must therefore attend to the well-being of these critical service providers if we expect to improve the lives of people with disabilities.

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9. Do you support the integration mandate in the Americans with Disabilities Act, ADA and believe this mandate is a federal civil right?

YES. 9a. If elected what actions will you take to protect this right?

The Supreme Court upheld the ADA's integration mandate in its Olmstead decision. I support this mandate and I will work to sustain it by appointing federal judges who will respect and uphold the law as understood in Olmstead. I will also work to implement policies, including support for passage of MiCASSA, that will make this federal civil right a reality in the lives of individual Americans with disabilities.

10. Will you include people with disabilities, including ADAPT members, in the development of all policies that effect the community long term service and support system?

YES. My administration will reflect the diversity of America. This means ensuring that the people who experience the impact of various programs and policies most directly are full participants in the development and implementation of those programs and policies. I welcome the involvement of the disability community, including ADAPT members, in ensuring that my administration moves forward in ending the Medicaid institutional bias once and for all.

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