My regular readers know I have spent most of my career working with people with disabilities. For the past seven years, I have been working to connect individuals with intellectual disabilities and/or autism to community-based services that support people to live as independently as possible.
While there is sometimes tension because service providers have a duty of care, people with disabilities want the right to take some risks. The duty of care means that service providers have to keep people safe, and the disabled community wants to make their own decisions, even if mistakes are made. Don’t we all learn by trial and error?
Anyway, the sad truth is community-based services are not an entitlement. Everyone who wants services has to apply and be found eligible. Codified in Medicaid and Medicare, institutional care (like nursing home beds) is an entitlement-anyone who needs them can get them. I call it a sad truth because institutional care is more expensive, and it is the thing most of us don’t want or need.
Eligibility-based services like food stamps, cash grants, SSI, and community-based services require yearly proof of eligibility; income and resources must be below a limit. Essentially, in order to maintain the services, people must remain low income. We also must certify annually that the disability continues and the services are still needed. In the intellectual disability world, the need for supports can decrease because independent living skills are learned. But I have never known a disability to go away.
The general community believes these programs are riddled with fraud. That’s not true for the disabled community because our limited life experience and education means we don’t earn life-sustaining wages, and we can’t anyway if we want to keep the services that help us keep our lives on track.
Medicaid Fraud Reform: Ensuring Care Continuity
We also have plans with written goals, and some of us “shack up” because we lose benefits and services if we marry. But I digress.
If applications for assistance are increasing, look at the economy. Even some federal workers turned to food banks and welfare recently. It feels like our senior leaders are only making the situation worse, and we are the ones who are viewed as being too expensive. We cannot allow further retrenchment of our rights and the programs and services we need.
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